What youll learnMedicine degrees are for students ready to make a long-term commitment to becoming a doctor. Youll spend five years at university (four if youre on a graduate course), then youll work with patients. Further training will be required as you specialise in a particular branch of medicine.

Some courses are divided into pre-clinical and clinical parts; others are more integrated. Some adopt a systems-based approach (the cardiovascular system, the nervous system, etc); others a problem-based approach.

The early part of the course will develop your basic skills and knowledge to prepare you for your hospital experience. There will be teaching in general medicine and surgery, while subsequent years will cover major clinical specialities (such as renal medicine, oncology, and neurology).

By the time you graduate you should be fit to begin on-the-job training. You wont be expected to know it all, but you should be able to assess a patient and manage treatment. You will understand disease and advise on healthy living.

You should have developed a certain level of compassion for your patients. Delivering bad news to a patient or their family will never be easy, but a caring attitude and an interest in the patients needs are important aspects of being a doctor. You will gain an understanding of the legal and ethical issues that come with a career in medicine.

How youll learnYou will learn through lectures, seminars, tutorials, lab work and bedside demonstrations. Your study includes hospital placements. Expect a challenging workload, with constant assessment through written and practical (clinical) exams, as well as coursework.

Entry requirementsMost universities demand top grades. If you have good A-levels (or equivalent) in chemistry, biology, maths and physics, you should have all the medical schools open to you.

Work experience in a health or social care setting will help your application. You need to apply early (in October) and youll be required to sit a test and attend an interview as part of admissions processes.

What job can you get?After graduation youll begin a two-year training programme in a hospital. Youll then train to specialise in a specific field, perhaps surgery or general practice. The length of training depends upon what you choose. You always have the option of moving into research.

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University subject profile: medicine - The Guardian

This article was originally published here

Int J Psychiatry Med. 2020 Sep;55(5):341-348. doi: 10.1177/0091217420951038.

ABSTRACT

Technology in medicine has been rapidly evolving over the past decade, greatly improving the quality and types of services providers can offer to patients. Physicians in training are eager to embrace these novel innovations, and medical school and residency educators strive to offer learning experiences of a high standard that are relevant. One example of an emerging healthcare innovation is telemedicine, which permits the provision of medical care to patients away from clinics and hospitals, bringing patient-centered care to the patient. It has proven to be cost-effective, improve health outcomes, and enhance patient satisfaction. This article describes the development and structure of our family medicine residency programs telemedicine curriculum, first created in 2016 in response to the growing demand for this type of healthcare delivery model. There is discussion about the history of telemedicine, and about what contributed to its growth. A timeline of the steps taken to create our new telemedicine residency curriculum is reviewed, along with the key components that contributed to its success. The Lessons Learned section provides other educators insight into the strengths and opportunities revealed during the creation of the curriculum, and guidance on how the curriculum could be further enhanced.

PMID:32883143 | DOI:10.1177/0091217420951038

View original post here:

Telemedicine: The art of innovative technology in family medicine - DocWire News

Sovah Family Medicine-Brosville will reopen Tuesday with certified family nurse practitionerKristen Grabowski as the provider.

The facility closed in July 2018 after a provider left, according to Kelly Fitzgerald, a spokesperson for Sovah-Health.

"Were thrilled to reopen next week,"Fitzgerald wrote in a Friday email to the Register & Bee.

Grabowski will specialize in general health, preventative medicine, hypertension, diabetes, geriatrics and womens health at the clinic that will be open from 8 a.m. to 5 p.m. Monday-Friday, with the exception of lunch from noon to 1 p.m.

Walk-ins, appointments and telehealth visits will be available.

Grabowski worked in the intensive care unit at Sovah Health before she joinedSovah Family Medicine-Danville in November 2009. She received her Master of Science degree in nursing fromSouth University in Savannah,Georgia, and herBachelor of Science degree in nursing fromWestern Governor University in Salt Lake City, Utah.

The practice is at 10390 Martinsville Highway. For more information, call (434)799-2500.

With a weekly newsletter looking back at local history.

Visit link:

Sovah Family Medicine-Brosville to reopen Tuesday | Business News | godanriver.com - GoDanRiver.com

The funds will be used to reduce medical school loan debt for Black students currently enrolled and receiving financial aid - totaling about $100,000 per student.

ATLANTA It's a major gift to an Atlanta-based historically Black college aimed at helping close the gap in medical disparities in America.

On Wednesday, Morehouse School of Medicine announced they received a $26.3-million donation from Bloomberg Philanthropies, the organization founded by former New York City Mayor Michael Bloomberg.

The donation is part of a greater $100-million fund for students attending the nation's four historically Black medical schools, including Morehouse School of Medicine.

According to the school, the funds will be used to reduce medical school loan debt for Black students currently enrolled and receiving financial aid - totaling about $100,000 per student.

Bloomberg himself taped a video message to highlight why the investment is so critical for the country, and the communities of color that are often at high-risk when it comes to healthcare.

The statistics are troubling.

It's already a well-established trend that the coronavirus pandemic has been particularly deadly and devastating for Black Americans. But, according to a 2015 study by the Centers for Disease Control and Prevention, the population had higher death rates than Whites for all-cause mortality in all groups less than 65 years old.

And while studies have shown that Black infants are already more likely to die than their White counterparts, when they are cared for by Black doctors, that rate is cut in half, according to one most recent study.

But, Black doctors only make up 6 percent of physicians in America. Congress has introduced a bill that would put $1 billion toward diversifying medical schools, but Bloomberg's donation will go directly toward medical students studying in the field.

"That's why I made this gift," Bloomberg said. "America urgently needs more Black doctors."

"The data is clear, more Black doctors will mean more Black lives saved and more economic opportunity," Bloomberg said in a video statement announcing the donation. "So much is at stake, and the burden of school debt should never stand in the way."

According to the Association of American Medical Colleges, the average cost for medical school in 2016 was $232,800 at public institutions and $306,200 for private institutions - a steep barrier, and possible deterrent, for those who may not be able to afford medical school financially.

11Alive spoke to a few of those students who will benefit from the gift. They said they are still stunned by the surprise.

"It's a range of emotions," Kamron Robinson said. "From overly excited and joyous to very thankful. I think I woke up everybody in the house."

"It's just an overwhelming sense of gratitude," said Nikki Jones. "Just thankful to have some of the stress relieved of the debt that I have accumulated going through this journey of medicine.

According to the school, this is the largest scholarship it has ever received.

The financial gift comes after a flurry of other similar recent donations to Historically Black Colleges and Universities, including Spelman and Morehousecolleges, also here in Atlanta.

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Morehouse School of Medicine students get surprise news that $26M gift will help pay off their debt - 11Alive.com WXIA

It was about the 3rd week into Bastions recovery from his TPLO surgery and he was already having a rough time. Bastion was a gregarious yellow Labrador who had his injured stifle about 25 days ago. Fortunately, his family elected for him to have his stifle surgically reconstructed. Initially, he had recovered well from surgery. But one day in particular, he presented to the hospital because he had a brief setback. He was limping far more severely than what would be normally expected at this stage of recovery.

The osteotomy from his surgery had not yet completely healed and he was still in the middle of his prescribed 5 weeks of exercise strict restriction. His family was trying their best but Bastion wasnt having it. He was too active at home and his humans were growing frustrated. Anti-anxiety medications had been dispensed but they were not given. Instead, his family had decided to give him CBD oil at home. When I asked why the prescribed medications had not been given, the client responded, I found CBD oil at the local farmers market and I figured it would work just as well.

Like Bastion, an increasing number of pets are receiving cannabidiol (CBD) supplements. The popularity of CBD continues to rise and many clients are incorporating CBD as part of the medication protocol for their pets, either as an adjunct or, as alternative treatment option.

Perhaps the initial interest in the benefits of CBD can be traced back to 1998, or possibly earlier, when scientists at the National Institutes of Health discovered that CBD could protect cells from oxidative stress. These findings fueled interest in the human medical field and, in large part, that appeal has been transmuted into veterinary medicine. The regard for this molecule has risen to such levels that in many homes, CBD is being used as the sole treatment option for a variety of medical conditions.

Veterinarians are becoming more fluent in the fascinating pharmacology regarding the use of this phytocannabinoid. A recent survey indicated that most veterinarians (61.5%) felt comfortable discussing the use of CBD with their colleagues, but only 45.5% felt comfortable discussing this topic with clients.1 Furthermore, veterinarians and clients in states with legalized recreational marijuana were more likely to talk about the use of CBD products to treat canine ailments than those in other states.2 Lastly, CBD was most frequently discussed as a potential treatment for pain management, anxiety and seizures.1 At first glance, the use of CBD has tangential or limited relevance in the world of veterinary surgery. However, as one takes a closer look at the putative, and proven benefits, it is clear that we are just scratching the surface of its therapeutic benefits. This article takes a brief dive into the world of CBD and its promise in the field of veterinary surgery.

Pain

Whether you perform surgery within a specialty discipline (oncology, orthopedics, neurology, soft tissue surgery, mixed animal, oral/dental, etc), or surgery is only a small part of your general practice, every veterinarian endeavors to aggressively manage pain. The first choice for pain relief among many clinicians are the medications that have been more extensively studied including, but not limited to, anti-inflammatories, gabapentinoids, opioids, local anesthetics, and other analgesics (acetaminophen, amantadine, cerenia etc). These medications or a combination thereof, have been prescribed to treat pain from orthopedic surgery, soft tissue surgery, surgical neuropathic conditions, pain from intestinal surgery, to name just a few. In the most basic schema, pain is divided into four categories: nociceptive pain (a response to damaged tissue), neuropathic pain (a response to directly-damaged sensory or spinal nerves), centralized pain (the result of pain signals being improperly amplified), and inflammatory pain.1 Cannabinoids may have a role to play in mediating all four of these types of pain states. When tissue is damaged, histamine, serotonin, TNF-alpha, IL-1-beta, IL-6, and Il -17 6, and interleukin 17 are released.2 Cannabinoids bind to the CB1 receptors and attenuate the pain signal by slowing down the release of those neurotransmitters.3 This process can take place locally or in the central nervous system.3 Cannabinoids have also been shown to inhibit the release of GABA, a well known neurotransmitter associated with pain.3 Although there is a paucity of clinical research on the use of CBD to treat postoperative pain in the veterinary medical setting, there has been heartening research conducted in humans. Indeed, National Academies of Sciences, Engineering, and Medicine concluded that there is, substantial evidence that cannabis is an effective treatment for chronic pain in adults.

Opioids have long been the go to option, or cornerstone of pain management, however, the potential for the adverse events associated with the use of opioids in veterinary patients is universally accepted.38 I have seen how distressing it can be for a family to see their pet experiencing any of the unpleasurable side effects of opioids including urine retention, delayed bowel movements, whining, panting, disorientation, or other manifestations of dysphoria. Those are just some of the challenges that clinicians face when using opioids for chronic pain management. Considering the ongoing consequences of the opioid epidemic, there is a search for pain management solutions that are innovative, prone to less adverse events, and are more effective. As the scientific community begins to evaluate the evidence for use of CBD , it is clear that more research is needed.

Anecdotal reports of CBDs efficacy as a pain reliever are ubiquitous but more are turning to scientific data for evidence of CBDs efficacy. A study in 2020 evaluating effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients found that over half of chronic pain patients (53%) reduced or eliminated their opioids within 8 weeks after adding CBD-rich hemp extract to their regimens.5 Almost all CBD users (94%) reported quality of life improvements.5 And in a recent study evaluating orally consumed cannabinoids for long-lasting relief of allodynia in a mouse model, found that cannabinoids reduced hyperalgesia and a similar effect was not found with morphine.4 Mouse vocalizations were recorded throughout the experiment, and mice showed a large increase in ultrasonic, broadband clicks after sciatic nerve injury, which was reversed by THC, CBD, and morphine.4 The study demonstrated that cannabinoids provide long-term relief of chronic pain states.4 If research shows that use of cannabinoids in animals, specifically, CBD, can help to decrease the use of opioids for pain management, that would help make more animals comfortable and potentially help to fight the tragic epidemic of human prescription opioid abuse. Further research is needed in a variety of species, specifically, both the canine and feline species.

Bone Healing

Both general veterinary practitioners and veterinary surgeons commonly diagnose and treat fractures. A large retrospective study of fracture incidence in dogs in North America has not been published since 1994; however, the findings from that study are still informative regarding the frequency of bone injuries. That study demonstrated that approximately 24% of all patients in the population studied over a 10 year period were affected by a disorder of the musculoskeletal system, with fractures contributing the largest proportion (over 29%) of all of the diagnosis of the appendicular skeletal system.7 Although that research is dated, the conclusions from this study - at the very least, indicate that fractures are commonplace in the clinical veterinary setting.7 Fracture repair has gradually become more straightforward due to improvements in technology. Because of these innovations, speciality surgeons and general practitioners who repair fractures have begun to see better surgical outcomes. So whether you primarily stabilize fractures with implants, or if external coaptation of fractures with the intention to refer (or perhaps as the primary means of fixation) is your treatment of choice, all veterinary practitioners aim to help fractured bones heal quickly. Despite these technological improvements, bone healing can be protracted or non existent with some fractures. There are a variety of options at a veterinarians disposal to kick-start the healing process but perhaps in the near future, CBD may be added to that armamentarium. The effect of CBD in fracture healing has been investigated evaluating bone callus formation in femur fractures in a rat model.8 The findings demonstrated enhanced biomechanical properties of healing fractures in those given CBD compared with a control group.8 This effect was not found in those only given 9-THC. Moreover, the bone forming effects (osteogenic) of CBD were weakened when test subjects were given equal amounts of CBD and 9-THC.6 Another in vivo research study indicated that when CBD is incorporated into a surface that promotes bone growth (osteoconductive scaffold) it can stimulate stem cell migration and osteogenic differentiation.9 Further studies are needed to better evaluate the role of CBD in healing and bone metabolism of companion animals so that these findings can be applied in the clinical setting.

Additionally, cannabis has been shown to be a useful addition in treatment plans optimized to improve bone health in laboratory studies. A study endeavored to more closely understand the role of CB2 receptors in maintaining bone health. CB2 receptors in bone cells have been linked to maintaining bone density and stimulating growth, and may therefore have a part in reversing the effects of osteoporosis.10 One study evaluating role of CB2 receptors, found that in mice whose genes had been altered to remove the CB1 or CB2 receptors, those that developed signs of bone weakness that were far more pronounced than those in the control group.12 Another study in 2009, investigated the relationship between CB2 expression and bone disease in humans. The study found that people with dysfunctional CB2 receptors to have significantly weaker hand bones.11

Arthritis

Osteoarthritis (OA) affects many dogs, large and small. Most often, OA is the consequence of a developmental orthopedic disease that often affects a single joint or a pair of joints, and, less often, affects multiple joints. It is axiomatic that Mother Nature likes symmetry thus developmental orthopedic diseases frequently affect both left and right joints. For example, hip dysplasia is reportedly bilateral in >60% of affected dog,s13 and elbow dysplasia is bilateral in approximately 50% of affected dogs.14 Osteoarthritis occurs secondary to a myriad of primary orthopedic conditions that affect a variety of joints including: the hip (most common causes of OA in the hip: hip dysplasia, Perthes disease); stifle (patellar luxation, cranial cruciate ligament disease, osteochondritis dissecans [OCD]); elbow (elbow dysplasia, elbow OCD, fragmentation of the medial coronoid process, incomplete ossification of the humeral condyle); shoulder (shoulder OCD, developmental shoulder subluxation); tarsus (OCD of the talus), and carpus (carpal laxity, carpal subluxation secondary to chondrodystrophy); and metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joint degenerative osteoarthritis (digital osteoarthritis) .

Cannabinoids were found to treat pain secondary to inflammation in a variety of studies on humans. Some of the most compelling research has shown that cannabis can reduce the inflammation in the joint caused in human patients diagnosed with immune mediated arthritis.15 One study found that cannabinoids could simultaneously reduce the secretion of cytokines involved in inflammation from one type of TH immune cells, which were being under-produced, while also increasing their numbers to correct their scarcity.15 Furthermore in a study in 2003, researchers found that plant-based cannabinoids could suppress the expression of interleukin-1betaone of the most prominent markers for inflammation in patients with rheumatoid arthritisby as much as 50%.16 And finally, in 2006, transdermal applications of CBD were shown to decrease biomarkers that can contribute to neurogenic inflammation in a sample of arthritic rats. 17

A report published in the journal of PAIN, lead by researchers at Baylor College of Medicine revealed the results of a large, double blinded, placebo controlled study on the positive effects CBD had in the fight against osteoarthritis.18 The study was designed with two main goals: The first portion of the research studied the effect CBD had on the inflammatory molecules and cells in mice.18 The second portion of the study, investigated whether CBD improved the quality of life in dogs diagnosed with osteoarthritis. In lab tests and in mouse models, CBD significantly decreased the production of natural chemicals that promote inflammation and it increased the natural chemicals that fight inflammation.18 Essentially, what they saw was a drop in proinflammatory cytokines and an increase in anti-inflammatory cytokines. 18 For dogs with osteoarthritis, CBD significantly decreased pain and increased mobility in a dose-dependent fashion. Importantly, A lower dose of liposomal CBD was as effective as the highest dose of nonliposomal CBD, indicating that the effect of CBD was quicker and more effective when CBD was delivered encapsulated in liposomes than without.18 Blood samples indicated no significant harmful side effects, or adverse events, over the 4-week analysis period.18 Although this study is very promising and it supports the safety and therapeutic potential of hemp-derived CBD for relieving arthritic pain in dogs, it is important to consult with your pets veterinarian before giving any supplement or medication.

In the veterinary population, use of cannabidiol and other alternative treatments may have the potential to obviate the need for other medications, and thus spare patients from adverse effects associated with their use. More likely, the use of cannabinoids could be additive or synergistic in a multimodal treatment strategy and could increase quality-of-life issues associated with painful arthritic conditions.

Intervertebral Disk Disease

As our patients age, discs in the spine also undergo degenerative changes. Thus, degeneration of intervertebral discs is evitable. This process of degeneration is multifactorial process and it involves hypoxia, inflammation, neoinnervation, accelerated catabolism, and reduction in water and glycosaminoglycan content.39 The magnitude and severity of disc degeneration can vary widely between patients. The most common locations of clinically relevant disc disease are located in the cervical spine, thoracolumbar spine, and the lumbosacral spine.40 Although there are various manifestations of disc disease, broad classifications of Hansen Type I and Type II are typically used to describe the condition. In short, disc material may either extrude (acute herniations) or protrude (chronic herniations), both of which compress the spinal cord which ultimately can cause pain, paresis, paralysis and other neurological deficits.40 The prevalence of thoracolumbar disc disease dogs has been estimated at 3.5%.40 Depending on the neurologic examination, diagnosis, severity, prognosis, and other factors, surgery may be recommended to decompress the spinal cord.

After surgical decompression, there are a host of challenges that the the patient, the family, and the surgeon, may have to work through including a potentially protracted recovery, recurrence of neurological signs, post surgical pain, spinal instability, urinary disorders, (cystitis, urinary tract infection, urinary retention, micturition disorders), ascending myelomalacia, and others.41 Could CBD play a part in helping to improve those affected by disc disease pre-, intra-, or post-operatively and what types of spinal disorders could benefit from CBD? A study conducted on the use of CBD in mice with degenerative disc disease showed promise in mitigating the effect of disc damage and wear.19 Instead of being ingested orally, CBD was injected at the site of the disc. Researchers investigated the effects of cannabidiol intradiscal injection using a combination of MRI and histological analyses.19 A puncture was created in the disc and then CBD was injected into the disc (30, 60 or 120 nmol) shortly after.19 The effects of intradiscal injection of cannabidiol were analyzed within 2 days by MRI.17 Fifteen days later, the group that received cannabidiol 120 nmol was resubmitted to MRI examination and then to histological analyses after the cannabidiol injection.19 What they found was that cannabidiol significantly decreased the effects of disc injury induced by the needle puncture.19 These results suggest that this compound could be useful in the treatment of intervertebral disc degeneration perhaps using a novel route of administration.

Unfortunately, the exact mechanism for how CBD oil helped protect disc damage is still being investigated. The hope is that the neuroprotective properties of cannabidiol can also be found in the study of canine and feline disc disease to ultimately improve functional recovery.

References:

Kogan L, Schoenfeld-Tacher R, et al. US Veterinarians' Knowledge, Experience, and Perception Regarding the Use of Cannabidiol for Canine Medical Conditions. Front Vet Sci. 2018;5:338.

Abd-Elsayed A., Deer T.R. (2019) Different Types of Pain. In: Abd-Elsayed A. (eds) Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-99124-5_3

Manzanares J, Julian MD, Carrascosa A. Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes Curr Neuropharmacol. 2006 Jul; 4(3): 239257.

Abraham AD, Leung EJ, Brenden A, Wong BA, Rivera ZM, Kruse LC, et al. Orally consumed cannabinoids provide long-lasting relief of allodynia in a mouse model of chronic neuropathic pain. 2020 Jun;45(7):1105-1114. doi: 10.1038/s41386-019-0585-3. Epub 2019 Dec 7.

Capano A, Weaver R, Burkman E. Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study. Postgrad Med. 2020 Jan;132(1):56-61. doi:10.1080/00325481.2019.1685298. Epub 2019 Nov 12.

Abraham AD, Leung EJ, Wong BA, Rivera ZM, Kruse LC, Clark JJ, Land BB. Orally consumed cannabinoids provide long-lasting relief of allodynia in a mouse model of chronic neuropathic pain. Neuropsychopharmacology. 2020: 45:11051114.

Johnson, J., Austin, C., & Breur, G. Incidence of Canine Appendicular Musculoskeletal Disorders in 16 Veterinary Teaching Hospitals from 1980 through 1989. Veterinary and Comparative Orthopaedics and Traumatology, 07(02), 5669. (1994). doi:10.1055/s-0038-1633097

Kogan NM, Melamed E, Wasserman E. Cannabidiol, a Major Non-Psychotropic Cannabis Constituent Enhances Fracture Healing and Stimulates Lysyl Hydroxylase Activity in Osteoblasts J Bone Miner Re. 2015 Oct;30(10):1905-13. doi: 10.1002/jbmr.2513. Epub 2015 May 10.

Kamali, A., Oryan, A., Hosseini, S., Ghanian, M. H., Alizadeh, M., Baghaban Eslaminejad, M., & Baharvand, H. Cannabidiol-loaded microspheres incorporated into osteoconductive scaffold enhance mesenchymal stem cell recruitment and regeneration of critical-sized bone defects. Materials Science and Engineering: (2019). C, 101, 6475. doi:10.1016/j.msec.2019.03.070

Bab I, Zimmer A. Cannabinoid Receptors and the Regulation of Bone Mass. British Journal of Pharmacology. 2007 153:182-188 doi:10.1038/sj.bjp.0707593

I. Idris, A. Cannabinoid Receptors as Target for Treatment of Osteoporosis: A Tale of Two Therapies. Current Neuropharmacology. 2010. 8(3), 243253. doi:10.2174/157015910792246173

Meliha Karsak et al. The Cannabinoid Receptor Type 2 (CNR2) Gene Is Associated with Hand Bone Strength Phenotypes in an Ethnically Homogeneous Family Sample. Human Genetics. 2009. 5:629-36 doi:10.1007/s00439-009-0708-8.

Loder, R. T., & Todhunter, R. J. The Demographics of Canine Hip Dysplasia in the United States and Canada. Journal of Veterinary Medicine. 2017 115. doi:10.1155/2017/5723476

ONeill DG, Brodbelt DC, Hodge R,. Church DB, Meeson RL. Epidemiology and clinical management of elbow joint disease in dogs under primary veterinary care in the UK. Canine Medicine and Genetics. 2020 volume 7:1

Susan H. Pross et al. Differential Suppression of T-cell Subpopulations by THC (delta-9- tetrahydrocannabinol). International Journal of Immunopharmacology 12, no. 5 (1990): 539-44. doi:10.1016/0192-0561(90)90118-7

Robert B. Zurier et al. Suppression of Human Monocyte Interleukin-1 Production by Ajulemic Acid, a Nonpsychoactive Cannabinoid. Biochemical Pharmacology. 2003 4:649-55. doi:10.1016/s0006-2952(02)01604-0.

D.c. Hammell et al. Transdermal Cannabidiol Reduces Inflammation and Pain-related Behaviours in a Rat Model of Arthritis. European Journal of Pain. 2015 6:936-48. doi:10.1002/ejp.818

Verrico, C. D., Wesson, S., Konduri, V., Hofferek, C. J., Vazquez-Perez, J., Blair, E., Halpert, M. M. A randomized, double-blind, placebo-controlled study of daily cannabidiol for the treatment of canine osteoarthritis pain. 2020. Pain. doi:10.1097/j.pain.0000000000001896

Silveira, J. W., Issy, A. C., Castania, V. A., Salmon, C. E. G., Nogueira-Barbosa, M. H., Guimares, et al. Protective Effects of Cannabidiol on Lesion-Induced Intervertebral Disc Degeneration. 2014. PLoS ONE 9:12 doi:10.1371/journal.pone.0113161

Yam, M., Loh, Y., Tan, C., Khadijah Adam, S., Abdul Manan, N., & Basir, R. . General Pathways of Pain Sensation and the Major Neurotransmitters Involved in Pain Regulation. International Journal of Molecular Sciences. 2018 19(8), 2164. doi:10.3390/ijms19082164

Costigan, M., Scholz, J., & Woolf, C. J. Neuropathic Pain: A Maladaptive Response of the Nervous System to Damage. Annual Review of Neuroscience. 2009 32(1), 132. doi:10.1146/annurev.neuro.051508.135531

Arora A, Taliyan R, Sharma PL. Ameliorative Potential of Cannabis Sativa Extract on Diabetes Induced Neuropathic Pain in Rats. International Journal of Pharmaceutical Sciences and Research 1. 2010 https://www.researchgate.net/publication/216536386_Ameliorative_potential_of_cannabis_sativa_extract_

Mark S. Wallace et al., Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy. 2015. Pain 16(7): 616-27 doi:10.1016/j.jpain.2015.03.008.

Gruen, M. E., Roe, S. C., Griffith, E., Hamilton, A., & Sherman, B. L.. Use of trazodone to facilitate postsurgical confinement in dogs. Journal of the American Veterinary Medical Association. (2014) 245(3), 296301. doi:10.2460/javma.245.3.296

Serra, G., & Fratta, W. A possible role for the endocannabinoid system in the neurobiology of depression. Clinical Practice and Epidemiology in Mental Health. 2007. 3(1), 25. doi:10.1186/1745-0179-3-25

Kim, E. J., Pellman, B., & Kim, J. J. Stress effects on the hippocampus: a critical review. Learning & Memory. 2015. 22(9), 411416. doi:10.1101/lm.037291.114

Demirakca, T., Sartorius, A., Ende, G., et al. Diminished gray matter in the hippocampus of cannabis users: Possible protective effects of cannabidiol. 2010. Drug and Alcohol Dependence. doi:10.1016/j.drugalcdep.2010.09.020

Mateus M. Bergamaschi et al. Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Nave Social Phobia Patients. Neuropsychopharmacology. 2011 36(6):1219-26 doi:10.1038/npp.2011.6.

Jos Alexandre S Crippa et al. Neural Basis of Anxiolytic Effects of Cannabidiol (CBD) in Generalized Social Anxiety Disorder: A Preliminary Report. Journal of Psychopharmacology. 2010. 25: 1doi:10.1177/0269881110379283.

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Zieba, J., Sinclair, D., Sebree, T., Bonn-Miller, M., Cannabidiol (CBD) reduces anxiety-related behavior in mice via an FMRP1-independent mechanism. Pharmacology Biochemistry and Behavior. 2019. doi:10.1016/j.pbb.2019.05.002

Pamplona, F. A., da Silva, L. R., & Coan, A. C. Potential Clinical Benefits of CBD-Rich Cannabis Extracts Over Purified CBD in Treatment-Resistant Epilepsy: Observational Data Meta-analysis. 2018. Frontiers in Neurology, 9. doi:10.3389/fneur.2018.00759

Palmieri B, Laurino C, Vadal M. A therapeutic effect of cbd-enriched ointment in inflammatory skin diseases and cutaneous scars. Mar-Apr 2019;170(2):e93-e99. doi: 10.7417/CT.2019.2116.

Sangiovanni, E., Fumagalli, M., Pacchetti, B., Piazza, S., et al.. Cannabis sativa L. extract and cannabidiol inhibit in vitro mediators of skin inflammation and wound injury. (2019). Phytotherapy Research. doi:10.1002/ptr.6400

B. Van Klingeren and M. Ten Ham. Antibacterial Activity of 9-tetrahydrocannabinol and Cannabidiol. 1976. 42(1-2): 9-12 doi:10.1007/bf00399444.

Giovanni Appendino et al. Antibacterial Cannabinoids From Cannabis Sativa: A StructureActivity Study. 2008. Journal of Natural Products 71(8):1427-430, doi:10.1021/np8002673

McIver, V., Tsang, A., Symonds, N., Perkins, N., et al. Effects of topical treatment of cannabidiol extract in a unique manuka factor 5 manuka honey carrier on second intention wound healing on equine distal limb wounds: a preliminary study. 2020. Australian Veterinary Journal. doi:10.1111/avj.12932

White, D. M., Mair, A. R., & Martinez-Taboada, F. Opioid-free anaesthesia in three dogs. Open Veterinary Journal. 2017 7(2), 104. doi:10.4314/ovj.v7i2.5

Hansen T, Smolders LA, Tryfonidou MA, et al: The Myth of Fibroid Degeneration in the Canine Intervertebral Disc: A Histopathological Comparison of Intervertebral Disc Degeneration in Chondrodystrophic and Nonchondrodystrophic Dogs. Vet Pathol 2017 Vol 54 (6) pp. 945-952.

40. Jeffery ND, Levine JM, Olby NJ, et al: Intervertebral disk degeneration in dogs: consequences, diagnosis, treatment, and future directions. J Vet Intern Med 2013 Vol 27 (6) pp. 1318-33.

41. Balducci F, Canal S, Contiero B, et al: Prevalence and Risk Factors for Presumptive Ascending/Descending Myelomalacia in Dogs after Thoracolumbar Intervertebral Disk Herniation. J Vet Intern Med 2017 Vol 31 (2) pp. 498-504.

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Unraveling the use of CBD in veterinary medicine - Jill Lopez

By Jess Williams

Las Cruces is a long way from Burbank, but what Johnny Carson and Jay Leno did for national TV, local host Sam Stichter is working to do for viewers here.

Stichter said the show has built an audience of about 25,000 viewers since debuting April 18. He agreed to answer some questions about it.

Bulletin: What was the motivation to start the show?

Stichter: My producer, Chris Soular, who is also the owner and operator of the Las Cruces Channel, was looking to do a uniquely local late-night TV show using a "Tonight Show" style formatthat features an opening monologue, interviews with guests on the couch and entertainment segments on each show, includinglocal musicians/bands, magicians and artists.

Bulletin: When did the show start, and how do you keep it going?

Stichter: The first show aired Saturday, April 18. We keep it going by building awareness of the show on Facebook, Twitter, YouTube, Comcast/Xfinty Channel 98 and by word ofmouth. Eachshow has grown in viewership. Our Aug. 15, 2020 was our most-viewed show with more than 25,000 viewers!

Bulletin: Who has been, in your opinion, the best guest youve had on so far, and why?

Stichter:While all our guests gave been great, I truly enjoyed having country singer Frank Ray on the show. He was very willing to do an interview segment, sing several songs andevenparticipate in a "skit" that featured him singing a song. Just an all-around nice guy who, although he's had some major success in the country music industry, is still veryhumble and wants to entertain the people of Las Cruces.

Bulletin: Who would you like to have on who has not agreed?

Stichter: While most everyone we have contacted has agreed to be on the show, we are still working on getting former WBA Light Middle Weight Champion boxer Austin "NoDoubt"Trout. Weare hopingtohave him on the show to promote his next fight. We would also like to have Las Cruces country singer BriBagwell on the show.

Bulletin: What are your criteria when choosing your guests?

Stichter: We look for a variety of people. Some are known in the Las Cruces area as entertainers, politicians, business owners, etc. Some are people who have a greatstoryoraninterestingprofession. Our main criteria is that when viewers tune into the show, they will be entertained by the guests on the show.

Bulletin: Whats your job history?

Stichter: From 1993 - 2002, I hosted a TV show in Reading, Pennsylvania (my original hometown), called "Community Calendar." It featured local guests from the city and county who werepromoting eventsthat were coming into the area, such as the Shriner's Circus, sporting events, fairs and carnivals, etc. In 2000, I received my certification in education. I taught for two years in Reading, PA as an elementary school teacher while continuing to host my TV show. In 2004, I moved to Las Cruces to teach at Las Cruces Public Schools. Today, I'm a computer science teacher at Lynn Middle School. I received my Ph.D. in curriculum and instruction from NMSU in 2019. I have taught at NMSU in the past as an adjunct instructor.

Bulletin: What are some typical questions you ask your guests?

Stichter: Some typical questions include: What is your connection to Las Cruces? Were you born in Las Cruces?How long have you been (acting, singing, performing, etc.)? When and where are you going to performing next? What got you into (politics, magic, business, etc.)? Where are some of the places you (worked, performed, visited, etc.)? What is your motivation?

Bulletin:Whats the craziest thing thats happened on the show since it started airing?

Stichter: When we first started planning the show in February, the plan was for me to have a sidekick. Then COVID-19 hit and we realized that we couldn't have somebody on the show next to medue to social-distancing protocols. As we were getting to ready to air our first show in April, everyone in the community was rushing to the stores to get toilet paper, hand sanitizer,etc.I decided that I was going to bring a roll of toilet paper on the show with me as a joke. My wife, Bonnie, said, in reference to the toilet paper, "Is that your sidekick?" I grabbed aSharpie and drew a "happy face" on the side of the roll of toilet paper and gave him the name Scott. "Scott" now appears with me on every show and the guests often talk to him.

Bulletin:What platforms and/or cable providers do people need to watch the show?

Stichter:Facebook, Twitter, YouTube (Search for Las Cruces Channel). Also on Comcast/Xfinity Channel 98. New shows air Saturday nights at 9 p.m.

Bulletin: What are your top three goals in doing the show?

Stichter: To continue to feature the "movers and shakers" of Las Cruces on each show, tTo offer a variety of entertainment segments each (avoid being stale and predictable) and to entertain the great people of Las Cruces during a time that entertainment choices in the area are extremely limited.

Bulletin: What else should our readers know?

Stichter: I write my own opening monologue, including my own jokes, which can be very challenging, and all of the interview questions. I sometimes ad-libbased on the guests and their reactions to certain questions. I have been asked to sing along with guests and dance, I give it my best, but I don't do either well. My students at Lynn Middle School think it'spretty cool when I show them clips from the show.

To contact Stichter, call 575-202-0616

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Laughter is the best medicine and Dr. Stichter makes house calls - Las Cruces Bulletin

Precision and personalised medicines are more than products, they are services in their own right. So, how should pharma approach this uncharted territory to ensure targeted therapies work for patients?

Personalised and precision medicines are exciting fields that focus on the development of treatment and prevention strategies for a single patient or patient group. The treatments are developed using cutting- edge technologies such as genomic sequencing and genetic engineering, helping to account for the individual variability in both patient and disease characteristics.

This has gained a lot of attention in recent years due to revolutionary breakthroughs in debilitating chronic diseases such as cancer. Traditionally, cancer patients are treated using one size fits all interventions like chemotherapy, radiotherapy and surgery. These vary in their effectiveness and result in damage to healthy tissues.

Personalised and precision medicine, however, can offer specialised treatments that target the patients unique cancer subtype, its genetic mutations, and the affected tissues.

These therapies involve novel pathways and complex processes to aid and deliver treatment, making each therapy a service in its own right. They depend on many touchpoints, stakeholders, partnerships and interdependencies to treat patients.

As a result, designing suitable services to support patients, caregivers and healthcare providers throughout the treatment pathway is essential. However, doing so successfully depends on understanding how to best approach the design of services in this challenging landscape.

Optimising the service behind the personalised and precision medicine is crucial for turning the treatment into a viable and differentiated option for patients. To make a real difference and ensure the therapy is competitive, we need to adopt a service design approach.

Service design is a multidisciplinary art and science that enables us to take a holistic view of the service experience, along with a deep understanding of the target groups, such as patients and healthcare professionals, and the context they operate in. This can include using empathic methodologies, such as in-depth interviews and field studies.

Gaining a comprehensive understanding of the customers needs, how they experience the current service, and how future services address their unmet needs.

Involving different stakeholders throughout the design process to gain a wide range of knowledge and expertise, and to further drive customer-centricity across the business.

Using visual tools such as sketches, maps and prototypes to improve and ease communication and collaboration between the different stakeholders involved in the creative process (surpassing language and knowledge boundaries).

Following a learning-by-doing approach via continuous prototyping and testing to evaluate solutions before investing time and resources on development.

Understanding how the customer experiences the whole service journey and then identifying insight gaps and opportunities for service innovation by looking at the big picture.

Personalised and precision medicines are naturally patient-centred (compared to traditional pharmaceuticals), as the individual patient is central to the product design. Taking this empathic approach throughout the design process provides a deeper understanding of those needs as well as their context.

This means not only adopting collaborative thinking during the design phase but also during production and development.

To deliver these unique therapies to patients, pharmaceutical companies must partner with a wide range of specialised third parties including laboratories, manufacturers, shipping and storing providers.

Looking at the entire service and all of its touchpoints from above is crucial

By engaging with multidisciplinary teams from all levels across the organisation, as well as numerous stakeholders during the co-creation process, you will increase the organisations knowledge and expertise, resulting in better and more fit-for-purpose solutions. Bring this sense of collaboration into the design process to encourage a higher level of consistency, placement and commitment to the patient and ensure they are at the centre of the service philosophy.

Novel therapies require designers to be adaptive. New developments such as changes in the supply chain, shorter genomic sequencing process or the need for an additional quality assurance step, often lead to changes to the envisaged treatment pathway. As a result, it is necessary to have a view of the whole service, in one place, which can be continuously updated.

Visual tools such as customer journey maps and service blueprints are a core part of service design. Journey maps (such as the one featured on p.16) provide an overarching view of the customer experience, along with the pain points, gaps, unmet needs and opportunities for engagement. Service blueprints visualise the process behind the service and the people impacted by it. These tools not only make it easier to understand the service, but they can also help simplify communication and increase alignment between the many individuals engaged in the project.

For personalised and precision medicines, patient journeys and service blueprints can help capture the front-end of the service, which is visible to patients, and the back-end processes, which are used by healthcare professionals. This gives us insights into the interactions, touchpoints and relationships between the patient and various stakeholders, such as the different healthcare professionals, carers and patient groups. Looking at the entire service and all of its touchpoints from above is crucial for making improvements that enrich the customer experience.

CAR-T is a new individualised cancer immunotherapy that has taken precision medicine to a new level. In a nutshell, CAR-T therapy involves extracting T-cells (a type of white blood cells that play a key role in immune response) from the patient, genetically engineering them to target the cancer cells and infusing them back into the patients body.

The CAR-T treatment pathway for a blood cancer involves a uniquely large number of stakeholders, touchpoints and interdependent processes that take place both in the front-end (i.e. visible to the patient) and back-end (i.e. visible to healthcare professionals). Below is a high- level overview of a typical CAR-T journey that can illustrate this complexity:

1. After the patient has identified as a suitable candidate for CAR-T therapy, they are referred by their primary oncologist to a specialised treatment centre to further assess treatment eligibility

2. Once eligibility has been established, the patient undergoes leukapheresis to extract T-cells

3.The samples are sent to a separate facility where they are frozen and prepared for shipping

4. The cells are then sent to a manufacturer where they are genetically engineered to target the patient's cancer cells and multiplied - to create the CAR-T product

5.The product needs to be shipped back to the treatment centre and stored frozen until the patient is ready for infusion

6. The shipping and manufacturing processes can take 34 weeks, during which the patient receives bridging therapy (to slow down disease progression)

7.A few days before the infusion, the patient undergoes lymphodepleting chemotherapy to prepare their body

8. After the infusion, the patient needs to be closely monitored for side effects for 1-3 weeks. Some side effects (e.g. Cytokine Release Syndrome) can require hospitalisation

9. The post-infusion period involves continuous tumour assessment and long-term follow-up

We recently pitched to a pharmaceutical company preparing to launch their new CAR-T therapy to help them design a set of patient-and caregiver-supporting services. We quickly became aware ofthe complicated nature of this therapy and decided to kick off by mapping the treatment pathway and the actors involved.

We normally kick off this type of project by conducting primary research with customers (using empathic methodologies) to generate insights that can inform the journey design. However, due to its novelty, it was difficult to access patients who have recently undergone CAR-T therapy. Instead, we carried out in-depth interviews with different types of stakeholders who had considerable experience working on early CAR-T therapies and clinical trials. This gave us insights into the healthcare professionals experience and visibility into the back-end processes.

The insights we gathered allowed us to understand the experience of patients and their caregivers. We could identify their emotional, practical and information-related needs and highlight the pain points that need to be addressed by the future services.

We also created empathy maps, another tool from the service design toolkit, to visually articulate what we know about the customers.

Once we completed the CAR-T patient and caregiver empathy maps, we created the CAR-T journey. The process relied heavily on co-creation by gathering input from key collaborators from the client company, including both medical and commercial personnel.

The continuous consolidation of insights from primary research, secondary research and stakeholder research was highly iterative. This ensured that the journey captured the envisaged treatment pathway in an accurate and comprehensible manner and that we were able to identify insight gaps as they emerged. From there we could then initiate the required steps to address them through additional research.

When executed correctly, a good customer journey is also adaptive and can be re-worked to reflect the changes that naturally occur over time. This is particularly important for journeys that have beencreated pre-launch and need to be revised, post-launch, to align with the emerging reality of the treatment, and for dealing with complicated treatments that are prone to nuanced changes. Both of these scenarios were true in the case of the CAR-T treatment.

The patient journey can also be used in collaborative design workshops with the client and their partners, as it successfully communicates a complicated pathway in a structured, easily digestible visual manner. It acts as a common language that different collaborators from different roles and backgrounds can use to achieve a shared understanding of the envisaged process and the end-to-end customer experience.

Last and perhaps most importantly it can be used to inform and generate new service ideas collaboratively using the journey as a stimulus, by focusing on key pain points and unmet needs.

This type of work is not possible without service design methodologies. These tools enable a diverse group of professionals from different roles and companies to come together and benefit from holistic, visual, customer-centred tools like empathy maps and customers journeys that make iteration and co-creation possible.

To find out how we can help you design a service for a complex medicine, contactsimon.young@fishawack.com

If you would like to request a free, full copy of our CAR-T Service experience map (snippet pictured above) please get in touch withnatasha.cowan@fishawack.com

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In the precision medicine era, the line between products and services is blurred - PMLiVE

Tom Hanks and his wife, Rita Wilson, were among the earliest celebrities to catch the novel coronavirus. In an interview at the beginning of July, Hanks described how differently COVID-19 had affected each of them in March.

My wife lost her sense of taste and smell, she had severe nausea, she had a much higher fever than I did. I just had crippling body aches, he said. I was very fatigued all the time and I couldnt concentrate on anything for more than about 12 minutes.

Why does COVID-19 present such different symptoms or none at all in different people?

Preexisting conditions can only be part of the story. Hanks is over 60 and is a Type 2 diabetic, putting him in a high-risk group. Nevertheless, he survived his brush with the virus with no pneumonia and apparently without any long-lasting effects. Knowing what causes variation in different patients could help physicians tailor their treatments to individual patients an approach known as precision medicine.

In recent years, a gene-centric approach to precision medicine has been promoted as the future of medicine. It underlies the massive effort funded by the U.S. National Institutes of Health to collect over a million DNA samples under the All of Us initiative that began in 2015.

But the imagined future did not include COVID-19. In the rush to find a COVID-19 vaccine and effective therapies, precision medicine has been insignificant. Why is this? And what are its potential contributions?

We are a physician geneticist and a philosopher of science who began a discussion about the promise and potential pitfalls of precision medicine before the arrival of COVID-19. If precision medicine is the future of medicine, then its application to pandemics generally, and COVID-19 in particular, may yet prove to be highly significant. But its role so far has been limited. Precision medicine must consider more than just genetics. It requires an integrative omic approach that must collect information from multiple sources beyond just genes and at scales ranging from molecules to society.

Inherited diseases such as sickle cell anemia and Tay-Sachs disease follow a predictable pattern. But such direct genetic causes are perhaps the exception rather than the rule when it comes to health outcomes. Some heritable conditions for instance, psoriasis or the many forms of cancer depend on complex combinations of genes, environmental and social factors whose individual contributions to the disease are difficult to isolate. At best, the presence of certain genes constitutes a risk factor in a population but does not fully determine the outcome for an individual person carrying those genes.

The situation becomes yet more complicated for infectious diseases.

Viruses and bacteria have their own genomes that interact in complex ways with the cells in the people they infect. The genome of SARS-CoV-2 underlying COVID-19 has been extensively sequenced. Its mutations are identified and traced worldwide, helping epidemiologists understand the spread of the virus. However, the interactions between SARS-CoV-2 RNA and human DNA, and the effect on people of the viruss mutations, remain unknown.

Tom Hanks and his wife caught the virus and recovered in a matter of weeks. Presumably each was infected over the course of a few minutes of exposure to another infected person, involving cellular mechanisms that operate on a timescale of milliseconds.

But the drama of their illness, and that of the many victims with far worse outcomes, is taking place in the context of a global pandemic that has already lasted months and may continue for years. People will need to adopt changes in their behavior for weeks or months at a time.

What should a precision medicine approach be in a pandemic? The gene-centric vision of precision medicine encourages people to expect individualized gene-targeted fixes. But, genes, behavior and social groups interact over multiple timescales.

To capture all the data needed for such an approach is beyond possibility in the current crisis. A nuanced approach to the COVID-19 pandemic will depend heavily on imprecise population level public health interventions: mask-wearing, social distancing and working from home. Nevertheless, there is an opportunity to begin gathering the kinds of data that would allow for a more comprehensive precision medicine approach one that is fully aware of the complex interactions between genomes and social behavior.

With unlimited resources, a precision medicine approach would begin by analyzing the genomes of a large group of people already known to be exposed to SARS-CoV-2 yet asymptomatic, along with a similar-sized group with identified risk factors who are dying from the disease or are severely ill.

An early study of this kind by Precisionlife Ltd data mined genetic samples of 976 known COVID-19 cases. Of these, 68 high-risk genes were identified as risk factors for poor COVID-19 outcomes, with 17 of them deemed likely to be good targets for drug developments. But, as with all such statistical approaches, the full spectrum of causes underlying their association with the disease is not something the analysis provides. Other studies of this kind are appearing with increasing frequency, but there is no certainty in such fast-moving areas of science. Disentangling all the relevant factors is a process that will take months to years.

To date, precision medicine has proven better suited to inherited diseases and to diseases such as cancer, involving mutations acquired during a persons lifetime, than to infectious diseases. There are examples where susceptibility to infection can be caused by malfunction of unique genes such as the family of inherited immune disorders known as agammaglobulinemia, but these are few and far between.

Many physicians assume that most diseases involve multiple genes and are thus not amenable to a precision approach. In the absence of the kind of information needed for a multi-omic approach, there is a clear challenge and opportunity for precision medicine here: If it is to be the future of medicine, in order to complement and expand our existing knowledge and approaches, it needs to shift from its gene-centric origins toward a broader view that includes variables like proteins and metabolites. It must consider the relationships between genes and their physical manifestations on scales that range from days to decades, and from molecules to the global society.

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How to use precision medicine to personalize COVID-19 treatment according to the patient's genes - The Conversation US

ANN ARBOR, Mich. This back-to-school season is unlike any other as many families make decisions about sending their children back to school in person or trying to navigate how to support their childs remote learning from home.

With many families anxious about starting the school year during a pandemic, a panel of experts from Michigan Medicine C.S. Mott Childrens Hospital will help answer parents top questions during a live Q & A.

The live discussion will be held on Thursday, Sept. 3 at 12 p.m. EST on both the @MottChildren and @MichiganMedicine Facebook pages as well as the @UMichMedicine and @MottChildren Twitter accounts and Michigan Medicine YouTube channel.

The video of the chat will also be available on these platforms for those who would like to view it afterwards.

Experts will address such topics as socialization concerns, supporting emotional and mental health during remote learning, advice for families of children with special learning needs, screen time and safety surrounding learning "pods" with neighbors and classmates.

Attendees may ask questions live at the time of the event or add them to the event discussion area on Facebook to be considered.

The discussion will be moderated by developmental behavioral pediatrician Jenny Radesky, M.D. Other panelists include pediatric psychologist Melissa Cousino Hood, Ph.D., pediatric psychiatrist Sheila Marcus, M.D. and pediatric infectious disease specialist Alison Tribble, M.D.

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Michigan Medicine Pediatric Experts to Answer Back-to-School Questions in live Q&A - University of Michigan Health System News

By COLLIN GALLANT on September 5, 2020.

cgallant@medicinehatnews.com

In response to reports stating British Army tank training may be scrapped at CFB Suffield, the Canadian Department of National Defence says the base has many functions training domestic and allied forces.

We are working closely with our British counterparts as they continue to plan a variety of training exercises for their soldiers and units, read a statement in response to questions from the News.

Officials also made public that Advanced Tactical Aviation exercises will be held at CFB Suffield over the last two weeks in September involving the 408 Tactical Helicopter Squadron, based in Edmonton.

The issue stems from reports that the British Ministry of Defence is contemplating options to avoid major upgrade costs on its fleet of heavy tanks by mothballing them to concentrate resources on emerging battlefield trends, like drone aircraft and cyber security.

That would end tank training at the Canadian base near Medicine Hat that operated for nearly 50 years in partnership between the two countries.

That report is due to be presented to civilian government officials in London in early Novembers.

DND officials told the news it is still too early to speculate about British army training needs in the future, but regular and reserve units of the Canadian Forces, as well as NATO contingents, also use the base in conjunction with BATUS and Defence Research and Development Canada station.

According to media reports from the U.K., the countrys 200-plus Challenger 2 heavy tanks, including about two dozen training units at CFB Suffield, are in need of substantial upgrades.

Along with Warrior armoured fighting vehicles, one option suggests mothballing the 1990s-era tanks rather than allotting new money to keep them battle-ready for another 15 years.

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DND working with British Army on their plans for Suffield - Medicine Hat News

By GILLIAN SLADE on September 5, 2020.

gslade@medicinehatnews.com

In the final weeks of the official 2019/2020 influenza season there were exceptionally low levels.

According to the FluWatch report, issued by the Public Health Agency of Canada, the percentage of positive tests remained at the lowest level recorded for the past nine seasons.

COVID-19 contributed to this, according to the report, due to changes in healthcare-seeking behaviour, the impact of public health measures such as social distancing and the testing capacity for influenza testing.

The peak of the influenza season appears to have taken place in mid-March nationally, which is about nine weeks earlier compared to the past five seasons.

The season ran from Aug. 25, 2019 to Aug. 22, 2020. Based on data collected in November and December, 2019 the effectiveness of influenza vaccine was measured.

It was estimated to be 58 per cent effective for any influenza, 44 per cent effective for influenza A (H1N1), 62 per cent effective for influenza A (H3N2) and 69 per cent effective for influenza B. It was particularly effective for children up to age 19, there was a good level of protection among working age adults 20 to 64 years. Among adults over 65 years, although imprecise due to small numbers, was lower at 18 per cent, the report states. Additional numbers are still to come.

The last influenza update for Alberta was issued on May 7. There had been 8,470 laboratory confirmed cases of flu, 1534 people had been hospitalized, and 39 deaths.

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Last period of flu season saw very low levels - Medicine Hat News

Tom Jurkowsky| The Fayetteville Observer

For the past several years, the Department of Defense (DoD) has been relentless in its attempt to cut 18,000 medical positions. The cuts represent a 20 percent reduction and would affect all the military services.

At Fort Bragg, both the Joel and Robinson outpatient facilities would be closed or downsized. Beneficiaries would be forced to obtain care from civilian providers, potentially creating health care shortages for both military beneficiaries and civilians seeking care in surrounding communities.

Congress fortunately has not yet authorized DoD to make the cuts. Last year, Congress directed a pause to ensure DoD conducted an assessment on the impacts such cuts may have on beneficiaries. This included not just the cost effectiveness of the cuts but whether civilian providers were even able to accommodate the military beneficiaries.

This year the House Armed Services Committee has once again made the right decision, telling DoD to conduct a more accurate and complete evaluation of its proposal by including provisions in its version of the National Defense Authorization Act (NDAA) that increase transparency, DoD reporting requirements and congressional oversight of the medical facility restructuring and personnel reductions.

The Armed Services Committee, like the General Accountability Office (GAO), told DoD that it needed to do a more accurate and complete evaluation of civilian care availability for its beneficiaries active duty members, their families and retired military personnel who qualify for medical care.

In its study of the issue, the GAO said DoDs civilian health care assessments did not consistently account for provider quality. For example, GAO found that DoD considered the quality of nearby civilian providers for only one of 11 selected military treatment facilities. Similarly, DoD did not properly consider the distance beneficiaries would have to travel to get their medical care.

Another finding was the cost effectiveness of the cuts. GAO said DoD applied assumptions that likely under-estimated the cost effectiveness of military treatment facilities.

An additional concern is the impact a 20 percent cut in military personnel would have on the battlefield. Can the services absorb these reductions and still support combat operations, humanitarian aid and relief missions?

The militarys response to COVID alone has demonstrated the key role the military can play in such a crisis. Since the pandemic began its global scourge, nearly 4400 military medical personnel have surged to augment courageous civilian medical personnel at U.S. medical facilities. This number does not include the approximately 58,000 active duty, Reserve and National Guard personnel who have also supported the response.

The Army also deployed four active-duty field hospitals.

Secretary of the Army Ryan McCarthy himself has expressed concern over the manpower cuts. He has questioned how the cuts might impact medical research facilities with resultant battlefield consequences.

DoDs attempt to affect these cuts is not well thought-out. Unlike its colleagues on the House Armed Services Committee, the Senate Armed Services Committee has not included any provisions in its version of the NDAA to halt the cuts. Accordingly, a conference committee composed of both House and Senate members will now meet to resolve this issue and several others in order to finalize the fiscal year 2021 Defense authorization bill.

North Carolinas two senators, Senators Richard Burr and Thom Tillis, even though they may not be on the conference committee, should urge their Senate colleagues to join the House in disapproving DoDs efforts to ravage military medicine.

Any reforms aimed at increasing military medical provider readiness, achieving efficiencies and improving the patient experience should be supported. But these reforms must be achieved in a thoughtful manner.

Just recently, the civilian secretaries of all the military branches, along with the uniformed heads of the services, called on Defense Secretary Mark Esper to suspend any planned moves of medical personnel or resources. They said the proposed end-state that DoD wants represents a disparate structure that hinders coordination of response to contingencies such as a pandemic.

For all the politically appointed civilian service secretaries and the uniformed service leaders to tell DoD they disagree with an action is unprecedented and speaks volumes. Hopefully, the Senate conferees, including Senators Burr and Tillis, will see the significance of this memo and act accordingly.

Tom Jurkowsky is retired Navy rear admiral who served on active duty for 31 years. He is a board member of the Military Officers Association of America (MOAA), a non-profit advocacy organization that supports a strong defense and its people. His book The Secret Sauce for Organizational Success: Communications and Leadership on the Same Page, was recently released. He lives in Annapolis, Maryland.

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U.S. Senate, including Tillis and Burr, must act to save military medicine - The Fayetteville Observer

CARLSBAD, Calif., Sept. 2, 2020 /PRNewswire/ --Ionis Pharmaceuticals, Inc. (NASDAQ: IONS) announced the publication today of the results from a compassionate-use study evaluating IONIS-PKKRx and IONIS-PKK-LRx in patients living with severe bradykinin-mediated angioedema in The New England Journal of Medicine (NEJM). IONIS-PKKRx and IONIS-PKK-LRx are investigational antisense medicines designed to reduce the production of prekallikrein, or PKK, which plays a key role in the activation of inflammatory mediators associated with acute attacks of hereditary angioedema (HAE). In the study, researchers found that the drugs reduced plasma prekallikrein activity levels and showed evidence of clinical efficacy in reducing the number of breakthrough attacks per month in patients over the course of the treatment, including complete resolution in a patient with Type 1 HAE. To view the published study, please visit NEJM.org.

Hereditary angioedema is a rare autosomal dominant disease that results in recurrent, painful attacks of swelling affecting the arms, legs, face, intestinal track and airway. Without preventive treatment, attacks can be frequent and severe and, in some patients, life-threatening. The majority of HAE cases are caused by genetic mutations that lead to either a deficiency (Type 1 HAE) or dysfunction (Type 2 HAE) of C1 esterase inhibitor (C1-INH), which regulates multiple pathways, including the kallikrein-kinin and contact system. In the third, especially rare form of the disorder (Type 3 HAE or HAE-nC1-INH), which occurs predominantly in women, and in which the cause is often unknown, patients have a higher frequency of facial, pharyngeal and tongue swelling.

"The results of this study are encouraging and support continued development of IONIS-PKK-LRx as a potential treatment in patients with severe hereditary angioedema for whom current therapies offer limited therapeutic benefit. The study also highlights the progress we continue to make advancing investigational medicines that are wholly owned by Ionis," said Richard S. Geary, Ph.D., Ionis' executive vice president of Development and a co-author on the paper published in NEJM.

In the study, two patients Patient 1 with Type 1 HAE and Patient 2 with Type 3 HAE were first treated with IONIS-PKKRx for a period of 12 to 16 weeks, after which they received IONIS-PKK-LRx at a dose of 80 mg every three to four weeks for seven to eight months at the time of data analysis. During treatment with the ligand-conjugated IONIS-PKK-LRx and the unconjugated parent drug, IONIS-PKKRx, there was a clinically meaningful reduction in HAE attack rates in both patients. Plasma prekallikrein activity levels decreased substantially following treatment.

Physicians have long prescribed prophylactic treatment approaches, including C1-INH replacement therapies and more recently inhibitors of plasma kallikrein, to prevent and reduce the severity of HAE attacks. IONIS-PKK-LRx is an investigational antisense medicine that is being developed because it has the potential to provide significant efficacy with the convenience of once per month low volume subcutaneous injections.

Ionis' Forward-looking Statement

This press release includes forward-looking statements regarding Ionis' business and the therapeutic potential of IONIS-PKK-LRx, IONIS-PKKRx and Ionis' technologies and products in development. Any statement describing Ionis' goals, expectations, financial or other projections, intentions or beliefs is a forward-looking statement and should be considered an at-risk statement. Such statements are subject to certain risks and uncertainties, particularly those inherent in the process of discovering, developing and commercializing drugs that are safe and effective for use as human therapeutics, and in the endeavor of building a business around such drugs. Ionis' forward-looking statements also involve assumptions that, if they never materialize or prove correct, could cause its results to differ materially from those expressed or implied by such forward-looking statements. Although Ionis' forward-looking statements reflect the good faith judgment of its management, these statements are based only on facts and factors currently known by Ionis. As a result, you are cautioned not to rely on these forward-looking statements. These and other risks concerning Ionis' programs are described in additional detail in Ionis' annual report on Form 10-K for the year ended December 31, 2019, and the most recent Form 10-Q quarterly filing, which are on file with the SEC. Copies of these and other documents are available from the Company.

In this press release, unless the context requires otherwise, "Ionis," "Company," "we," "our," and "us" refers to Ionis Pharmaceuticals and its subsidiaries.

Ionis Pharmaceuticals is a trademark of Ionis Pharmaceuticals, Inc.

About Ionis Pharmaceuticals

As the leader in RNA-targeted drug discovery and development, Ionis has created an efficient, broadly applicable, drug discovery platform called antisense technology that can treat diseases where no other therapeutic approaches have proven effective. Our drug discovery platform has served as a springboard for actionable promise and realized hope for patients with unmet needs. We created the first and only approved treatment for children and adults with spinal muscular atrophy as well as the world's first RNA-targeted therapeutic approved for the treatment of polyneuropathy in adults with hereditary transthyretin amyloidosis. Our sights are set on all the patients we have yet to reach with a pipeline of more than 40 novel medicines designed to potentially treat a broad range of disease, including neurological, cardio-renal, metabolic, infectious, and pulmonary diseases.

To learn more about Ionis visit http://www.ionispharma.com or follow us on twitter @ionispharma.

SOURCE Ionis Pharmaceuticals, Inc.

http://www.ionispharma.com

Original post:

New England Journal of Medicine publishes study results evaluating Ionis antisense therapy in treatment of patients with hereditary angioedema -...