It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Thursday, February 09, 2023
Can I come, too? How tourism can include people whose health conditions usually keep them at home
Around 20 per cent of the world’s population suffer from chronic diseases such as diabetes, heart disease, cancer, or mental disorders — a group of people the travel industry needs to accommodate
Following the disruption of COVID-19, the global tourism industry has largely opened up again; however, travelling remains a serious challenge for a large group of people.
The World Health Organization estimates 20 per cent of the world’s population suffer from non-communicable chronic diseases such as diabetes, heart disease, cancer, or mental disorders.
These conditions can make travelling difficult, while some people may even avoid taking holidays altogether.
A cross-disciplinary research project from Edith Cowan University has highlighted the impacts this decision can have on people with these health challenges, and outlined the future repercussions for the industry as a whole.
Through collaboration between ECU’s School of Business and Law and its Centre for Precision Health, the project has put forth the concept of ‘travel therapy’, which sees tourism as a means of improving mental health and wellbeing.
Researcher Dr Jun Wen said it is vital the tourism industry catered more to vulnerable people with physical or psychological disorders, a market he described as important but too often overlooked.
“Most are able to travel but remain vulnerable during trips and need intensive services,” he said.
“The world has an ageing population, so there will be more and more people dealing with the challenges that brings, like dementia, physical limitations and so on.
“There are also more people being diagnosed with mental health issues, such as depression and anxiety.
“Tourism needs to be able to accommodate vulnerable travellers such as these for the industry’s survival — but also because health is important and as our previous work has shown, tourism can help support health.”
What the industry can do
Dr Wen said there are numerous initiatives which could make destinations more accessible for vulnerable people.
Strategies could be implemented throughout the tourism industry chain (food, accommodation, transportation, travel, shopping, and entertainment) and could include considerations or allowances for caregivers who may need to accompany travellers.
Dr Wen said education was critical.
“Staff and stakeholders need training to be made aware of vulnerable travellers’ needs and demands,” he said.
“This can include developing manuals to standardise services for vulnerable travellers, enhancing accessible infrastructure and equipping professional emergency and care facilities appropriately, such as with first-aid tools.
“The industry can also customise services for different traveller segments, such as people with dementia, depression or anxiety.”
Dr Wen said technological advances could also play a great role in bringing the benefits of tourism to more people.
“Not everyone can take physical trips,” he said.
“The tourism industry should develop virtual products that enable all travellers to be present in a destination and to enjoy fun and health-related benefits.”
Five medical organizations are recommending updated best practices for hand hygiene to protect patients and staff in healthcare settings. The recommendations emphasize the importance of healthy skin and nails and easy access to alcohol-based hand sanitizers.
Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene: 2022 Update, one in a series of expert guidance documents known collectively as the Compendium, was published today in the journal Infection Control & Hospital Epidemiology.
“Hand hygiene is a basic function of healthcare safety,” said lead author Janet Glowicz, PhD, RN, CIC, with the Centers for Disease Control and Prevention. “By engaging healthcare personnel and establishing reliable processes described in the Compendium, we can achieve effective, consistent hand hygiene. Commitment by healthcare leadership is also necessary to establishing a culture of safety.”
The document addresses how facilities can train healthcare personnel in proper technique, monitor their compliance, engage them in the selection of products to keep their skin healthy, and properly use gloves. It also discusses where facilities should place and how they should maintain alcohol-based sanitizer dispensers and sinks.
The guidance reviews the evidence around nail polish, gel, and shellac, which shows that short, natural nails with standard polish or no polish are easiest to clean. The authors found no new evidence specific to chipped nail polish and artificial nails but note previous findings that they can harbor germs. The guidance leaves specific policies about nail polish, gels, shellac, and artificial nail extenders to the discretion of infection prevention programs at each facility, with the exception of policies for those who scrub for surgery or work in high-risk areas. These personnel should maintain short, natural fingernails free of polish and nail extenders.
Citing research that shows only 7% of healthcare personnel effectively clean the entire surface of their hands, the guidance recommends ongoing training in handwashing and proper use of sanitizer. Thumbs and fingertips were most frequently missed.
The authors recommend that healthcare personnel not be provided with individual, pocket-sized hand sanitizers in lieu of wall-mounted sanitizer dispensers and emphasize that hand sanitizer dispensers always be widely available and never prohibited, even in situations when washing with soap and water are indicated. When healthcare personnel suspect organisms that are difficult to remove, such as C. difficile and noroviruses, healthcare personnel should wear gloves and follow structured techniques for hand washing and hand sanitizing. In addition, facilities should not top-off sanitizer dispensers meant for single use or provide antimicrobial soaps that contain Triclosan. Facilities also should discourage the use of double gloves, except in certain circumstances.
To encourage compliance and to support healthy skin and nails, facilities should include healthcare personnel in the selection of hand sanitizers and moisturizers, while ensuring the products are compatible with antiseptics and gloves used on site. Maintaining healthy skin is a crucial element of hand hygiene.
Surgical settings require special care, but waterless hand hygiene with surgical hand rubs is acceptable, especially as it improves compliance. Brushes should be avoided in surgery prep due to their negative impact on skin health.
This document updates the 2014 Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. The Compendium, first published in 2008, is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, with the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The Compendium is a multiyear, highly collaborative guidance-writing effort by over 100 experts from around the world.
Upcoming Compendium updates will include strategies to prevent catheter-associated urinary tract infections, Clostridium difficile infections, methicillin-resistant Staphylococcus aureus infections, and surgical site infections. Strategies for preventing central line-associated bloodstream infections and pneumonia were updated earlier in 2022. Each Compendium article contains infection prevention strategies, performance measures, and example implementation approaches. Compendium recommendations are derived from a synthesis of systematic literature review and evaluation of the evidence, practical and implementation-based considerations, and expert consensus.
###
About ICHE Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 24th out of 94 Infectious Disease Journals in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.
The Society for Healthcare Epidemiology of America (SHEA)is a professional society representing more than 2,000 physicians and other healthcare professionals around the world who possess expertise and passion for healthcare epidemiology, infection prevention, and antimicrobial stewardship. The society’s work improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers, hospitals, and health systems. This is accomplished by leading research studies, translating research into clinical practice, developing evidence-based policies, optimizing antibiotic stewardship, and advancing the field of healthcare epidemiology. SHEA and its members strive to improve patient outcomes and create a safer, healthier future for all. Visit SHEA online atshea-online.org,facebook.com/SHEApreventingHAIsandtwitter.com/SHEA_Epi.
JOURNAL
Infection Control and Hospital Epidemiology
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene: 2022 Update
The divergent goals of two opponents—whether they are individual people or entire nations—can be thought of as two points in a multi-dimensional space of possibilities, and the ensuing battle of wills can be described in terms of a ball bouncing around in this same space. When one party gains temporary control of the ball, they move it closer to where they want to to be, but their opponent is then liable to seize control and move the ball in the opposite direction. The focus of this paper is on conflicts that are of interest to evolutionary biologists—including those occurring between genes, between individuals, between the sexes, and between the generations. The geometric approach reveals that not only are these conflicts liable to continue indefinitely through evolutionary time, but that they are also able to spill out from the initial battleground and cause extensive collateral damage in areas where there is no actual disagreement. The damage is particularly devastating to complex organisms and social structures, and so conflict places an important barrier to the evolution of complexity. The geometric analysis finds that such collateral damage is greatly reduced if organisms and their societies embody the principle of modular design, which constrains the bouncing ball to move only in certain directions at any given time. This suggests that modularity is a crucial—and previously unappreciated—enabler of complex adaptation and transformative changes in social organisation, from the evolution of multicellular life to the emergence of superorganismal insect societies.
JOURNAL
Proceedings of the Royal Society B Biological Sciences
A recent study examined patients’ outcomes after receiving care based on scientific and clinical evidence. The work, which is published in Worldviews on Evidence-Based Nursing, also reviewed the extent and type of evidence-based practices (EBPs) performed across clinical settings.
A total of 636 published articles addressing EBP and patient outcomes met investigators’ inclusion criteria. There were many differences in approaches, designs, and outcomes measured among the articles included in the review.
Most articles (63.3%) were published in the United States, and 90% took place in the acute care setting. Various EBPs were implemented, with just over a third including some aspect of infection prevention, and most (91.2%) linked to reimbursement. The two most reported outcomes were length of stay (15%), followed by mortality (12%).
“Although our study revealed that EBP improves patient outcomes and reduces costs for healthcare systems, there is much opportunity to improve healthcare quality and safety with EBP as healthcare executives still do not invest enough in their budgets to ensure that all clinicians take this approach to care and that all care is evidence-based, not steeped in tradition, or outdated policies or procedures,” said corresponding author Linda Connor, PhD, RN, CPN, of The Ohio State University.
Additional Information NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com.
About the Journal Worldviews on Evidence-Based Nursing is a peer-reviewed journal and top information resource from The Honor Society of Nursing, Sigma Theta Tau International, that uniquely bridges knowledge and application, taking a global approach in its presentation of research, policy and practice, education and management, and its link to action in real world settings.
About Wiley Wiley is one of the world’s largest publishers and a global leader in scientific research and career-connected education. Founded in 1807, Wiley enables discovery, powers education, and shapes workforces. Through its industry-leading content, digital platforms, and knowledge networks, the company delivers on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, Twitter, LinkedIn and Instagram.
IMAGE: A FAMILY IN RURAL KENYA FIELD TEST THE POINT-OF-USE FLUORIDE BIOSENSORS.view more
CREDIT: CREDIT: JANET BARSOLAI
EVANSTON, Ill. --- Scientists from Northwestern University have collaborated on the implementation of an accurate, low-cost and easy-to-use test for detecting toxic levels of fluoride in water.
The new biosensor device developed at Northwestern has been field tested in rural Kenya, providing evidence that water testing for fluoride can be easily used outside of a lab and accurately interpreted by nonexperts.
Worldwide, it is estimated that tens of millions of people live in areas where the water supply is contaminated with toxic levels of naturally occurring fluoride, a colorless, odorless and tasteless substance. The scale of the issue has been difficult to measure because of the high cost or complexity of available testing options.
A major step toward addressing global health concerns over access to safe drinking water, the new proven testing method is the result of a rare collaboration between researchers in the fields of anthropology and synthetic biology.
Study findings will be published by NPJ Clean Water on Feb. 8, 2023, at 10 a.m. GMT/4 a.m. CST. After publishing the paper can be accessed here.
The study was co-led by Northwestern anthropologist Sera Young and synthetic biologist Julius Lucks. Young is an associate professor of anthropology and global health studies at Weinberg College of Arts and Sciences and a faculty fellow at the Institute for Policy Research (IPR). Lucks is professor and associate chair of chemical and biological engineering at McCormick School of Engineering. Lucks is also co-director of the Northwestern Center for Synthetic Biology, where Young is also a faculty member.
Young and Lucks say it is the first time they have collected field data together, and it shows what’s possible when social scientists and synthetic biologists put their heads together to address global challenges.
The project builds upon and finds a unique intersection for prior research conducted by both Lucks and Young, who are married.
In 2017, Young and colleagues developed the Water Insecurity Experiences Scales to provide a measurement of global water insecurity that takes human experiences into account. Young partnered with the Gallup World Poll to publish estimates for half of the globe using the WISE scale in 2022 in Lancet Planetary Health.
Prompted by Young’s research, Lucks and his lab began to investigate naturally occurring biosensors — molecules used by microbes to sense for the presence of contaminants. In 2020, they published work on repurposing biosensors in a cell-free synthetic biology system, allowing the detection of harmful water contaminants such as fluoride in the field, naming the technology platform ROSALIND.
To further Young’s research on improving global water security, the latest iteration of the Lucks Lab’s ROSALIND technology improved the speed and usability of the device to allow for easy transport to locations where harmful levels of fluoride are a safety concern.
The research team collected 57 water samples from 36 households in rural Kenya to evaluate the accuracy of the fluoride concentration measurement when compared with the gold-standard method of fluoride photometer. They also designed their studies to examine whether test results would be easily interpreted by non-expert users, a key indicator that the technology can have meaningful impact in addressing the global water crisis.
Results were excellent, showing that the point-of-use had an 84% chance of correctly predicting fluoride levels above the World Health Organization limit of more than 1.5 parts per million.
The tests also were found to be highly usable, with only 1 of 57 tests with an interpretation discrepancy between the user and scientific team.
“This is a whole new way to measure water quality,” Young said. “The study shows that we can get a test into people’s hands that is based on some very complex biology but works very simply.”
“It also points to the feasibility of such tests for other chemicals like lead and PFAS,” Lucks said.
Potential next steps for the point-of-use fluoride test could include mapping where geogenic fluoride is located globally.
Closer to home in Chicago, Young and Lucks are interested in investigating the usability of an at-home test for rapidly detecting lead in water, and in leveraging this study as a model for interfacing social sciences with synthetic biology to increase the impact of synthetic biology innovations.
The study, “The accuracy and usability of point-of-use fluoride biosensors: a field study in Nakuru County, Kenya,” will appear online Feb. 8, 2023, in Nature Partner Journals: Clean Water.
This work was supported by the Carnegie Corporation; Northwestern University’s Institute for Policy Research and the Crown Family Center for Jewish and Israel Studies; the support of the American people provided to the Feed the Future Sustainable Intensification Innovation Lab through the United States Agency for International Development Cooperative Agreement AID-OAA-L-14-00006; and the United States Army Contracting Command W52P1J-21-9-3023.
Acesulfame is a sweetener in sugar-free drinks and foods. As it cannot be metabolised in the human body, the sweetener ends up in wastewater after consumption and remains largely intact even in sewage treatment plants. A new study by the University of Vienna shows that the persistence of the sweetener varies with temperature as the concentration of the sweetener in wastewater varies with the seasons. The environmental geosciences team analysed how groundwater flows can be traced based on these seasonal fluctuations. Since residues of the sweetener end up in drinking water, acesulfame serves as an indicator of the origin and composition of our drinking water. The study has now been published in the journal Water Research.
The sugar substitute acesulfame is one of the most commonly used sweeteners in Europe. It is almost 200 times sweeter than sugar and temperature-stable, making it suitable for sugar-free baking and for sweetening most diet lemonades. Because the human body does not metabolise the substance, it ends up in wastewater when consumed in large quantities and remains there even after treatment, but in fluctuating concentrations. The new study by the University of Vienna shows that the substance is broken down to varying degrees over the year depending on the temperature. "For a long time, it was assumed that the potassium salt of acesulfame is not degraded at all in wastewater treatment plants. This is still true, but only in the cold season," explains Thilo Hofmann, deputy head of the Centre for Microbiology and Environmental Systems Science at the University of Vienna. "There were already initial indications that at least partial biodegradation takes place in summer. We can prove this in our study and systematically show for a longer period of time how the concentration of the sweetener in the water changes with the seasons."
Sweetener acesulfame: indicator for the flow paths of wastewater treated in sewage treatment plants
Acesulfame is a widely used indicator of wastewater discharges into surface waters and groundwater: since this sweetener is not completely degraded both in wastewater treatment plants and in the environment – after it has been discharged into water bodies with the treated wastewater – a detection of the substance in water indicates that and how much treated wastewater has entered groundwater, rivers or lakes. "If you follow the traces of the substance, you can ultimately trace flow paths of the wastewater and its mixing with groundwater," Hofmann explains. With the knowledge of seasonal fluctuations in the degradation of the substance, acesulfame becomes an even more meaningful tracer.
Computer models of groundwater flows enable risk prevention
"Our study shows that the seasonally fluctuating concentration of acesulfame can be used to better visualise and understand the processes in the subsurface, i.e. groundwater flows," says Hofmann. Wastewater components in drinking water can be recorded as well as the flow velocity of the groundwater and the mixing ratios of groundwater and river water. The environmental geoscientists evaluated river and groundwater samples that were collected regularly over eight years in a pre-alpine catchment. The research team linked their analyses to computer models that calculate water flows in the subsurface. "Such computer models are the key to risk prevention, because they can be used to understand how much river water and how much groundwater end up in the population's drinking water and how to optimise the operation of waterworks," adds the head of the research group.
Traces of the sweetener end up in drinking water
The sweetener acesulfame thus lays a tracer trail from wastewater to river and groundwater and finally to our drinking water. "The fact that acesulfame is not degraded is basically a good thing for us hydrogeologists, because we can draw valuable information from it," says Hofmann. He adds: "However, this fact also makes us aware of our lifestyle being reflected in the wastewater and thus also in the drinking water: The sugar substitute we consume ends up back in our drinking water – albeit heavily diluted, of course."
IMAGE: EMBL SCIENTISTS JUSTIN CROCKER AND LAUTARO GANDARA USED FOOD SOURCES INCORPORATING FRUIT GROWN IN AND AROUND EMBL IN THEIR EXPERIMENTS THAT BRIDGE NATURAL AND LAB ENVIRONMENTS TO UNDERSTAND THE EVOLUTION OF PHENOTYPES.view more
CREDIT: EMBL/ KINGA LUBOWIECKA
Most of his career, Justin Crocker, EMBL Heidelberg Group Leader, has been working at the interface of development and evolution. In two new studies led by Crocker, scientists have shown how using non-standard laboratory conditions and synthetic biology approaches can help us understand fundamental mechanisms that regulate the development and evolution of phenotypes.
In this, they are part of the growing field of phenomics – the systematic study of an organism’s traits and how they vary and change during development as well as in response to the environment. Phenotypic evolution becomes particularly interesting in light of global concerns such as climate change, where many animals are under pressure to adapt quickly to fast-changing environments.
The significance of studying phenotypes
Phenotypes are the observable characteristics of an organism – features such as behaviour, appearance, metabolism, gene expression patterns, etc. They result from interactions between the genotype – the information contained in DNA, and the environment. The phenotypes any organism exhibits often depend on precise decisions regarding which genes are expressed where and when.
In the two publications, the Crocker group and their collaborators provide novel insights into some of the key processes that determine the robustness of phenotypes and the appearance of new phenotypes during development.
This knowledge can help researchers better understand how diversity emerges during evolution in animals, and perhaps even predict ecological and environmental patterns of change in the phenotypes of wild animal populations.
Studying phenotypes in laboratories vs “the wild”
Biologists often study organisms under well-standardised laboratory conditions to ensure rigour and reproducibility. However, this also increases the risk of missing effects that only become apparent outside of these narrow ranges of conditions.
Using fruit-fly embryos and a variety of other model systems, Crocker and his team have been demonstrating the importance of moving beyond standardised laboratory conditions and challenging established assumptions when it comes to understanding the development and evolution of phenotypes.
The team used food sources incorporating fruit grown in and around the EMBL Heidelberg campus in their experiments that bridge natural and lab environments to understand the evolution of phenotypes.
In their experiments, they found that the loss of a certain epigenetic mark, the H3K4 monomethylation, led to changes in behaviour, gene expression, metabolism, and even rates of offspring production.
“This epigenetic mark is present throughout the genome, but its deletion seems to have little to no impact on gene expression, which led scientists to hypothesise that it doesn’t play a major role in normal development and function,” said first co-author Albert Tsai, team leader at the Centre de Recherche en Biologie cellulaire de Montpellier (CRBM), former postdoc in the Crocker lab.
H3K4 monomethylation is found ubiquitously in almost every cell’s nucleus. “That led us to question why there is such an evolutionary drive to create these marks if it’s actually doing nothing,” said Tsai. The Crocker group was sure that they were missing something.
The scientists observed that the loss of H3K4 monomethylation led to changes, especially when the fruit-flies were fed on natural food sources, including fruit collected in and around the EMBL campus. In the absence of this mark, certain traits became sensitive to environmental conditions and to different genetic backgrounds. When exposed to high temperatures or when certain background genes were mutated, the organisms likewise responded differently.
“It challenges the current paradigm of standardising experiments as much as possible to focus on very specific conditions,” said Tsai. “We need to come up with controlled ways of bringing more natural environments into the lab.”
Synthetic biology and the study of phenotypes
In a second study, Crocker and his team questioned how new phenotypes emerge in the first place. This is a central question in evolutionary biology – for organisms to accumulate small changes that would be selected by the environment, there must be a way to continuously, quickly, and easily introduce variation in phenotypes.
While our genomes often accumulate small changes – called mutations – over time, these don’t always result in changes in phenotypes, or observable traits.
Next, the team introduced completely random sequences into the genome instead. In a natural context, random DNA sequences may arise in the genome due to viruses, or transposons – mobile genetic elements that actively move between different parts of the genome.
To the researchers’ surprise, with their synthetic DNA approach, they found that random sequences easily drove gene expression, and in all parts of the embryo.
“We have been talking about doing this for a long time, and everybody thought it was a bit crazy. Then we just went ahead and did it,” said Crocker. “In the field we often think about how expression is generated, how to activate genes, etc. This study makes us think that if any random sequence can drive expression, and we have a genome with millions of sequences – maybe the question is not so much how do you generate expression but how do you repress or control it.”
In future studies, the Crocker lab will continue to look deeply into the mechanisms that connect genotype and environment to phenotypes.
IMAGE: GREEN TIPPING IS A NEW RESEARCH PROJECT LED BY ALESSANDRO TAVONI, PROFESSOR AT THE DEPARTMENT OF ECONOMICS AT THE UNIVERSITY OF BOLOGNA, AND FUNDED BY THE EUROPEAN RESEARCH COUNCIL (ERC) WITH A CONSOLIDATOR GRANT WORTH EUR 1.8 MILLION.view more
CREDIT: UNIVERSITY OF BOLOGNA
To meet the challenge of ecological transition, technological solutions and economic decisions are not enough. Behavioural changes, both individual and societal, are also needed. But how can these changes be fostered? How widespread does a new positive behaviour have to be for even the most sceptical to commit to it?
This is the topic that Green Tipping will focus on. This new project is led by Alessandro Tavoni, professor at the Department of Economics at the University of Bologna, and was funded by the European Research Council (ERC) with a Consolidator Grant worth EUR 1.8 million.
"We know that it is very difficult to get people to abandon long-established behaviours, including those that are perpetuating dependence on fossil fuels, and this limits the effectiveness of policy choices, preventing the changes that would be necessary," Tavoni explains. "To overcome this obstacle, we are studying solutions to promote the adoption of positive behaviour in a targeted manner in order to reach a threshold beyond which a new sustainable behaviour spreads autonomously across the entire population."
In these cases, it is referred to as Social Tipping Interventions (STI), i.e. actions that promote positive changes that can spread across society. This is an emerging field of analysis that until now has only been analysed on a theoretical level or with small-scale experiments. The aim of Green Tipping is to explore these tools to find solutions for large-scale sustainable changes in individual and social behaviour.
"During the project, we will identify the conditions necessary to abandon widespread but climate-damaging social norms, and then test their effectiveness on a number of representative samples in different countries," explains Tavoni. "From the data gathered, we will then be able to fine-tune the identified solutions with controlled group experiments on specific targets, and then assess their social diffusion potential in the real world."
New economic model finds Fracture Liaison Services are highly effective
The newly developed model to estimate the health benefits and budget impact of Fracture Liaison Services (FLS) is an important tool to drive the prioritization of FLS provision within healthcare systems
IMAGE: THE BARS IN THE FIGURE INDICATE THE EXCESS TOTAL COST (IE, HEALTH AND SOCIAL CARE COSTS AS WELL AS THOSE REQUIRED FOR FRACTURE LIAISON SERVICE [FLS] OPERATION) IN LOCAL CURRENCY OF FLSS ABOVE THE TOTAL COST UNDER CURRENT PRACTICE PER YEAR. THE ORANGE LINE TRACKS THE NUMBER OF ADDITIONAL QUALITY-ADJUSTED LIFEYEARS (QALY) GAINED BY IMPLEMENTING FLSS (IE, ABOVE THOSE EXPECTED TO BE ACHIEVED WITHOUT THEM) PER YEAR. ADAPTED FIG. 2 OF PINEDO-VILLANUEVA ET AL. EXPECTED BENEFITS AND BUDGET IMPACT FROM A MICROSIMULATION MODEL SUPPORT THE PRIORITISATION AND IMPLEMENTATION OF FRACTURE LIAISON SERVICES. DOI: 10.1002/JBMR.4775view more
CREDIT: FROM PINEDO-VILLANUEVA ET AL. EXPECTED BENEFITS AND BUDGET IMPACT FROM A MICROSIMULATION MODEL SUPPORT THE PRIORITISATION AND IMPLEMENTATION OF FRACTURE LIAISON SERVICES. DOI: 10.1002/JBMR.4775
New research reveals that widespread Fracture Liaison Service (FLS) implementation would benefit patient outcomes, manifested in a significant reduction in subsequent fragility fractures and gains in quality of life, whilst at the same time reducing hospital bed days, surgeries, need for institutional social care, and their associated costs.
With populations ageing, the burden of fragility fractures on healthcare systems around the world is on the rise, resulting in a spiral of increased patient disability, loss of independence, and early mortality within the older population. Given that patients with a fragility fracture are at substantially high risk of subsequent fractures, effective secondary fracture prevention is of critical importance. In this regard, FLS have been shown to be an optimal way to systematically identify, assess, treat, and monitor patients who have recently sustained a fragility fracture, and they have been proven to reduce the risk of subsequent fractures in numerous studies and reviews.
Associate Professor Kassim Javaid, Lecturer in Metabolic Bone Disease and Honorary Consultant Rheumatologist, NDORMS, University of Oxford, UK, co-author of the study, stated:
“Although FLSs are highly effective in reducing the risk of subsequent fragility fractures and improving patient outcomes, the majority of healthcare settings that manage adult fracture patients do not have an FLS in place. In the European Union for example, 50% of countries reported FLS coverage in less than 10% of hospitals. We know that a major barrier to sustainable effective FLS implementation is a lack of national, regional, and local policy prioritisation and reimbursement. This new model makes visible both the invisible costs of fragility fracture and the expected net benefits from systematic FLS provision to patients and their families, clinicians, healthcare systems, and wider society. The flexibility of the model allows its implementation across different types of healthcare systems and populations and provides clear outputs tailored to a wide audience, giving decision makers critical information based on their local data to appropriately prioritise local implementation of FLS for patient benefit.”
The microsimulation model estimates the impact of FLSs compared to current practice for men and women 50 years of age or older with a fragility fracture. It provides estimates for health outcomes that include subsequent fractures avoided and quality-adjusted life years (QALYs), as well as resource use, and health and social care costs, including those necessary for FLSs to operate, over five years.
Based on an exemplar country the size of the United Kingdom, FLSs were estimated to lead to a reduction of 13,149 subsequent fractures and a gain of 11,709 QALYs over the first five years of FLS implementation. Hospital bed days would be reduced by 120,989 and surgeries by 6,455, whilst 3,556 person-years of institutional social care would be avoided. Expected costs per QALY gained placed FLSs as highly cost-effective at £8,258 per QALY gained over the first five years alone.
Associate Professor Rafael Pinedo-Villanueva, Senior Health Economist, NDORMS, University of Oxford, first author of the study, explains:
“With healthcare budgets being limited and increased pressures on healthcare providers, policy makers need to make informed decisions based not only on necessary investments but also on expected benefit to patients, impact on healthcare resource use, and cost impacts before they can prioritise secondary fracture prevention in relation to other health priorities. This model acts as a calculator for all these relevant outcomes and can be run for any country or region. When run with values for a country the size of the United Kingdom, it shows that the initial investment in FLS implementation, where extra costs are concentrated in the first year, is worthwhile. The costs then drop significantly thereafter as we see gains in QALYs over time as more and more fractures are avoided.”
“Further work to develop country-specific models is currently underway, and we expect that this will deliver crucial national-level data that can then be used to inform policy makers at the country level.”
The development of the model was carried out by experts from the University of Oxford and supported by the International Osteoporosis Foundation (IOF) Capture the Fracture® initiative, a programme which works to drive the implementation and sustainability of FLS worldwide, and which offers best-practice guidance and recognition to more than 800 FLS in all regions of the world.
Professor Cyrus Cooper, IOF President and co-author, concluded:
“This important model, essentially an ‘FLS cost and benefit’ calculator, provides significant evidence that secondary fracture prevention through FLS service provision is highly cost effective, with significant benefits for patients, their families, the healthcare system, and society as a whole.”
About Capture the Fracture® Capture the Fracture® (CTF) is a multi-stakeholder initiative, led by the International Osteoporosis Foundation (IOF), to facilitate the implementation of Post-Fracture Care (PFC) Coordination Programs, such as Fracture Liaison Services (FLS), for secondary fracture prevention. The CTF initiative, which celebrated its 10th year of service in 2022, aims to drive changes at local and regional levels to prioritize secondary fracture prevention. It sets global best practice standards and offers recognition for Fracture Liaison Services (FLS) through its Best Practice Framework. CTF also provides essential resources and documentation to build the case for prioritization of secondary fracture prevention and to help drive the implementation and quality improvement of FLS. Mentorship programs that support the development of FLS at the local level are also offered.
The Capture the Fracture® Partnership, a global initiative launched in 2020, is a collaboration between the International Osteoporosis Foundation (IOF), the University of Oxford, Amgen and UCB, amplifying the Capture the Fracture programme launched in 2012. It seeks to address the global health burden of osteoporosis through five interconnected pillars, following a comprehensive, top-down and bottom-up approach, and aligning stakeholders at the international, national and local level in prioritized countries across the Asia Pacific, Europe, Latin America and the Middle East. The aim is to prioritize PFC and drive more rapid uptake of PFC coordination programs around the world.
Currently, the CTF network includes 813 FLS in 53 countries worldwide. FLS are invited to apply for free assessment and recognition via the CTF website’s online Best Practice Framework application platform. https://www.capturethefracture.org #CaptureTheFracture
About IOF The International Osteoporosis Foundation (IOF) is the world's largest nongovernmental organization dedicated to the prevention, diagnosis, and treatment of osteoporosis and related musculoskeletal diseases. IOF members, including committees of scientific researchers as well as more than 300 patient, medical and research organizations, work together to make fracture prevention and healthy mobility a worldwide heath care priority. https://www.osteoporosis.foundation @iofbonehealth
About NDORMS The largest European academic department in its field, NDORMS is part of the Medical Sciences Division of the University of Oxford. It runs a multi-disciplinary programme of research and teaching, supported by an extensive grant portfolio. The Department is a growing community of over 500 staff, approximately 100 post-graduate students, more than 30 professors, several university lecturers, and senior researchers. Its highly skilled team has expertise in a broad range of areas, including orthopaedic surgery, inflammation, immunology, rheumatology, medical statistics, epidemiology, data science and clinical trials. The research work at NDORMS takes place across three world-leading research institutes: the Botnar Institute for Musculoskeletal Sciences, the Kennedy Institute for Rheumatology and the Kadoorie Centre. The co-location with NHS services at Oxford's Nuffield Orthopaedic Centre (NOC) puts the department in an excellent and rare position, where basic researchers work alongside clinicians. This substantially improves NDORMS’ research capability, improving access for researchers to patients, and facilitates the interaction between clinicians and scientists, which is essential for successful translational research. https://www.ndorms.ox.ac.uk/
