Improving outcomes for sepsis patients

More than 1 million sepsis survivors are discharged annually from acute care hospitals in the United States. Although the majority of these patients receive post-acute care (PAC) services, with over a third coming to home health care (HHC), sepsis survivors account for a majority of readmissions nationwide. Effective interventions are needed to decrease these poor outcomes.

A national study from the Center for Home Care Policy & Research at the Visiting Nurse Service of New York, in collaboration with the University of Pennsylvania School of Nursing (Penn Nursing), shows that the combination of early home health nursing and at least one outpatient physician visit in the first week after hospital discharge reduced the risk of 30-day hospital readmission for sepsis patients by seven percentage points. The investigators concluded that the combination of home nursing visits and early physician follow-up facilitates a coordinated care plan and early surveillance for new or recurrent problems.

“Our findings support integrated care management, including scheduling physician follow-up before discharge rather than recommending that patients schedule their own follow-up, as well as a clear communication that this is a sepsis survivor so HHC can activate early attention,” said Kathryn Bowles, PhD, FAAN, FACMI, van Ameringen Chair in Nursing Excellence, and the study’s co-principal investigator. “If translated nationally, this operational strategy could complement national and state initiatives to improve the acute and PAC outcomes of sepsis survivors.” “Our study revealed much room for improvement as only 28.1% of sepsis survivors transitioned to HHC received this intervention.”

The researchers’ findings have been published in the August issue of Medical Care in an article “Does Early Follow-Up Improve the Outcomes of Sepsis Survivors Discharged to Home Health Care?”

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Co-authors of the study include Partha Deb, PhD and Hoda Nouri Khajavi, MS, both of Hunter College, City University of New York; Christopher M. Murtaugh, PhD (Principal Investigator), Yolanda Barrón, MS and Penny H. Feldman, PhD all of the Center for Home Care Policy and Research, Visiting Nurse Service of New York; Mark E. Mikkelsen, MD, MSCE, Perelman School of Medicine at the University of Pennsylvania; and Stanley Moore, BS.

The study was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number R01NR016014.

https://www.eurekalert.org/pub_releases/2019-08/uops-iof080119.php

Pandemic bonds face scrutiny after Ebola outbreak yet to trigger payout

World Bank funding instruments issued to help emerging countries swiftly tackle pandemics have come under the spotlight after the latest deadly Ebola outbreak has yet to trigger a payout.

Following the 2013-2016 Ebola outbreak that ravaged Sierra Leone, Guinea and Liberia and killed at least 11,300 people, the World Bank launched a bond and insurance instruments in 2017 to establish a mechanism that would quickly deploy funds to help tackle outbreaks of infectious diseases.

But while another Ebola outbreak — the second worst on record — has been raging for a whole year and has been classed an international health emergency by the World Health Organization, the pandemic instruments have so far not paid out.

Payouts are triggered once a virus outbreak crosses an international border and claims at least 20 lives in each of at least two countries.

The virus has killed more than 1,800 people in Democratic Republic of Congo and two in neighboring Uganda – meaning the threshold for payouts have not been reached.

On Thursday, Congolese authorities confirmed that a third case had been diagnosed in the densely populated city Goma, increasing fears that the virus could take root in the trading hub on the Rwandan border, hundreds of miles away from where the outbreak was first detected.

Asked about the lack of a payout, Michael Bennett, head of derivatives and structured finance at the World Bank’s capital markets division, explained the pandemic bonds were structured to cover cross-border events.

For payouts to be triggered, they “require a set number of confirmed cases or deaths in more than one country”, he said.

“Then the payout is also dependent on how many deaths and how many countries are involved.”

APPROVAL PROCESSES

The Pandemic Emergency Financing (PEF), which includes funding for an Ebola outbreak, comprises $95 million of bonds and $55 million of insurance. It would also provide financing in event of pandemics caused by other infectious diseases such as Marburg, Crimean-Congo hemorrhagic fever or Lassa fever.

Payouts would be staggered: a death toll of 250 triggers a $45 million disbursement, while 750 deaths would bring another $45 million payout. The remaining $60 million is paid out when the death toll reaches 2,500.

Funded by the governments of Germany and Japan, the instruments carry a coupon of LIBOR plus 11.1%. According to data from Refinitiv, the bond is or has been held by asset managers such as Baillie Gifford, Amundi and Oppenheimer.

But the lack of payout from the World Bank instruments is raising questions over whether they can indeed offer governments timely help to tackle crises, given the stringent small print.

“The problem is that when there are catastrophes, there is often a lack of quick disbursing instruments because of very lengthy approval processes,” said Bodo Ellmers, head of policy at the European Network on Debt and Development (EURODAD).

“They raised the money ex-ante, so there is a pot of money available that can immediately kick in. The case we have now is that there is a financial need, but the criteria are so stringent that the facility is not disbursing.”

The World Bank’s Bennett said the pandemic facility had been very specifically designed to insure against cross-border events rather than single-country outbreaks.

But with the instruments due to mature next summer, the bank is examining possible changes to the structure, for instance, seeking out a cost-efficient way of insuring single-country events, he said.

It is also looking into instruments that could help tackle outbreaks of different viruses affecting humans, or even livestock such as pigs or poultry.

“Of course, we always run the risk of coming up with a structure that takes into account a previous event,” said Bennett. “If we now completely change the structure to pick up the current event it may not pick up a future one.”

https://www.reuters.com/article/us-health-ebola-worldbank/pandemic-bonds-face-scrutiny-after-ebola-outbreak-yet-to-trigger-payout-idUSKCN1UR5HD

Momenta Phama (MNTA) Launches Phase 2/3 Trial of M281; Granted FDA Fast Track

Momenta Pharmaceuticals, Inc. (Nasdaq: MNTA) announced the launch of an adaptive Phase 2/3 clinical study for its FcRn inhibitor nipocalimab. FDA Fast Track granted for Nipocalimab in wAIHA.

https://www.streetinsider.com/Corporate+News/Momenta+Phama+%28MNTA%29+Launches+Phase+23+Trial+of+M281%3B+Granted+FDA+Fast+Track+for+Nipocalimab+in+wAIHA/15768861.html

Could a ‘Manogram’ Replace a Prostate Biopsy?

Could imaging replace a painful biopsy in testing for prostate cancer?

Such is the vision of Jelle Barentsz, MD, PhD, from the Radboud University Medical Center in Nijmegen, the Netherlands, who recently presented data to support the use of a fast biparametric (bp) MRI technique for prostate imaging.

He positioned this as a first step in the workup for patients whose prostate-specific antigen (PSA) level is found to be elevated. Such imaging could spare men from the pain and complications of a prostate biopsy, at least in this first instance.

Barentsz proposed the term “manography.”

This could make MRI of the prostate for men of a certain age as routine as mammography screening for breast cancer is for women of a certain age, he suggested.

“MRI can be fast, noninvasive, accurate, and potentially less expensive [than biopsies],” Barentsz said.

When I first learned about this as-yet unrealized promise of using MRI as a routine screening modality for prostate cancer, offering the tantalizing prospect of avoiding biopsies, I thought, “sign me up!”

I speak as a 62-year-old who has been lucky enough to have had three — count ’em, three — ultrasound-guided prostate biopsies, all of which, fortunately, came back negative.

Given my family history and my high-normal levels of PSA, I discussed it with my primary care physician, and we agreed that it made sense for me to “man up” and have the biopsies.

Looking for Trouble

Screening for prostate cancer with the PSA blood test was once widespread in the United States but is now controversial.

Concerns over potential harms from overdiagnosis of lesions that may never spread led to recommendations against routine use of the PSA test.

PSA itself is a notoriously fickle marker that can be affected by many different factors, such as sexual intercourse, exercise, and diet, as reported by Medscape Medical News earlier this year.

The US Preventive Services Task Force (USPSTF) issued a statement that is lukewarm at best regarding prostate cancer screening for men in my age group — 55 to 69 years. The statement reads, in part, as follows:

“In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.”

The statement doesn’t fudge when it comes to older men, however: “The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older.”

[MORE]

https://www.medscape.com/viewarticle/916297

LHC partners announce acquisitions in Missouri, Alabama, Ohio

Just two days after announcing an acquisition of health care agencies in Maryland, Lafayette-based LHC Group and its joint venture partners announced acquisitions of three health care providers in Missouri, Alabama and Ohio.

LHC Group expects annualized revenue from the transactions of approximately $7.5 million and that it will not materially affect its 2019 diluted earnings per share. So far the company has acquired or agreed to acquire 15 home health, six hospice and three home and community based service locations in seven states and the District of Columbia, representing annualized revenue of approximately $81.2 million.

In Missouri, LHC Group and partner Capital Region Medical Center completed the purchase of SSM Health and the assets of a home health agency and a hospice agency in Mexico, Missouri, and one home health agency in Jefferson City. The three providers will change names and operate as Central Missouri Home Health and Central Missouri Hospice, respectively.

In Alabama, LHC Group and Atmore Community Hospital have finalized a partnership agreement to share ownership of a home health provider in Atmore, which will continue operating under as Atmore Community Home Care.

In Ohio, LHC Group has purchased two HCBS locations in West Union and Waverlyfrom Comfort Home Care. The agreement includes 100 percent of each location’s assets, each one will be consolidated under LHC Group’s existing HCBS provider, HomeCare by Blackstone, in Columbus. The two branches will operate as Comfort Home Care.

https://www.marketscreener.com/LHC-GROUP-INC-9875/news/LHC-partners-announce-acquisitions-in-Missouri-Alabama-Ohio-28999712/

Bayer sees potential future business in plant-based meat market

A Bayer executive on Thursday said the company was closely watching the plant-based meat market which has seen booming demand in recent years, adding that Bayer could potentially enter the market as an alternative protein source provider.

“They are sourcing different types of crops and that also could create opportunity for us, being a company that is a plant-breeding company,” Bob Reiter, Bayer’s head of research and development at the company’s crop science division, said in reference to plant-based meat companies.

Reiter made the remarks at an investor event in St. Louis, Missouri in response to a question by an analyst who wanted to know what impact the growth of plant-based meat substitutes would have on the company’s business.

Meat alternatives have seen booming demand as consumers are looking to add more plant-based protein to their diet, amid growing concerns about health risks from eating meat, animal welfare and the environmental hazards of intensive animal farming.

Companies including Beyond Meat and Impossible Foods, and even traditional meat producers including Tyson Foods Inc, Maple Leaf Foods Inc and Perdue Farms are cashing in on the trend, selling sausages, burgers and imitation ground beef largely made from pea protein or soy.

Analysts say there are no signs of the meat alternatives market slowing, with nearly 40% of consumers trying to add more plant-based protein to their diet, according to research group Mintel.

Germany-based Bayer, which acquired seed and pesticides maker Monsanto in a $63 billion deal last year, is the world’s largest seed and pesticides company by sales, leading the market in corn, soybean and cereal seed sales.

Reiter on Thursday said that in order for plant-based companies to produce at scale and succeed, they require efficient sources of amino acids and carbohydrates, which will bring them around to row crops that can be tilled and cultivated by machinery.

“We’re not going to scale peas to get to 10% of the alternative meat market,” Reiter said.

Beyond Meat’s latest burger is made from peas, brown rice, sunflower seeds and mung beans. Its chief executive, Ethan Brown, in the past said the company was exploring new protein sources, saying there are an “almost endless number of crops you can pull from.”

https://www.marketscreener.com/BAYER-AG-436063/news/Bayer-sees-potential-future-business-in-plant-based-meat-market-28999427/?countview=0

Iovance Biotherapeutics EPS misses by $0.09

Iovance Biotherapeutics (NASDAQ:IOVA): Q2 GAAP EPS of -$0.38 misses by $0.09.

Cash, equivalents, and short-term investments of $404.15M

Press Release

https://seekingalpha.com/news/3485630-iovance-biotherapeutics-eps-misses-0_09