The document discusses the role of diagnostics in preventing antimicrobial resistance (AMR). It notes that inappropriate antibiotic use is fueling the emergence of AMR globally and reducing treatment options. Currently 700,000 deaths per year are due to drug-resistant infections and this could rise to 10 million by 2050. Diagnostics can play a key role in optimizing antibiotic use, preserving new drugs, and enabling surveillance. The document outlines FIND's strategy to develop and promote rapid diagnostic tests to improve rational antibiotic use in low-resource settings and preserve antibiotics by enabling more targeted treatment.
Antibiotic resistance is one of the biggest threats facing us today!
European Antibiotic Awareness Day (EAAD) is part of the UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018, which focuses on antibiotics and sets out actions to slow the development and spread of antimicrobial resistance.
This year, to run in line with EAAD; Public Health England has established the Antibiotic Guardian pledge campaign. It calls on everyone in the UK, the public and healthcare community to become antibiotics guardian by choosing one simple pledge about how they will make better use of these vital medicines.
To ensure that the information and knowledge on Antibiotic Stewardship is disseminated to those practising healthcare across the nation, a series of awareness and educational events have been developed. These educational workshop events, to be held in Leeds, Birmingham and London, will provide guidance, resources and information for practitioners on topics associated with antibiotic awareness. The events will provide an opportunity to understand how you and your organisation can support combat the global challenge faced by antibiotic resistance whilst gaining advice, support and resources to inform patients and staff.
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
Antibiotic Guardian Leeds Workshop 20164 All of Us
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
Antibiotic Guardian London Workshop 20164 All of Us
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
Antibiotic resistance is one of the biggest threats facing us today!
European Antibiotic Awareness Day (EAAD) is part of the UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018, which focuses on antibiotics and sets out actions to slow the development and spread of antimicrobial resistance.
This year, to run in line with EAAD; Public Health England has established the Antibiotic Guardian pledge campaign. It calls on everyone in the UK, the public and healthcare community to become antibiotics guardian by choosing one simple pledge about how they will make better use of these vital medicines.
To ensure that the information and knowledge on Antibiotic Stewardship is disseminated to those practising healthcare across the nation, a series of awareness and educational events have been developed. These educational workshop events, to be held in Leeds, Birmingham and London, will provide guidance, resources and information for practitioners on topics associated with antibiotic awareness. The events will provide an opportunity to understand how you and your organisation can support combat the global challenge faced by antibiotic resistance whilst gaining advice, support and resources to inform patients and staff.
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
Antibiotic Guardian Leeds Workshop 20164 All of Us
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
Antibiotic Guardian London Workshop 20164 All of Us
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
Awareness Session On Antimicrobial resistance “Antimicrobials: Spread Awaren...Nimra zaman
The World Antimicrobial Awareness Week (WAAW) was introduced by the World Health Organization (WHO) to increase global awareness of antimicrobial resistance.
The WAAW takes place every year from 18-24th of November.
The theme of World Antimicrobial Awareness Week (WAAW) 2021 is ‘Spread Awareness, Stop Resistance’.
During this week best practices are shared among the general public, health workers and policy makers to show the importance of stopping the further emergence and spread of antibiotic resistance.
Dr. James Hughes - Combating Antimicrobial Resistance: The Way ForwardJohn Blue
Combating Antimicrobial Resistance: The Way Forward - Dr. James Hughes, Professor of Medicine and Public Health with Joint Appointments in the School of Medicine and the Rollins School of Public Health at Emory University, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
EVI and Hilleman Laboratories announce partnership to assess a new vaccine ag...hillemanlabs
Funding from European and Developing Countries Clinical Trials Partnership (EDCTP) will allow testing of a novel whole-cell inactivated oral vaccine in clinical trials in Europe and Africa.
Awareness Session On Antimicrobial resistance “Antimicrobials: Spread Awaren...Nimra zaman
The World Antimicrobial Awareness Week (WAAW) was introduced by the World Health Organization (WHO) to increase global awareness of antimicrobial resistance.
The WAAW takes place every year from 18-24th of November.
The theme of World Antimicrobial Awareness Week (WAAW) 2021 is ‘Spread Awareness, Stop Resistance’.
During this week best practices are shared among the general public, health workers and policy makers to show the importance of stopping the further emergence and spread of antibiotic resistance.
Dr. James Hughes - Combating Antimicrobial Resistance: The Way ForwardJohn Blue
Combating Antimicrobial Resistance: The Way Forward - Dr. James Hughes, Professor of Medicine and Public Health with Joint Appointments in the School of Medicine and the Rollins School of Public Health at Emory University, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
EVI and Hilleman Laboratories announce partnership to assess a new vaccine ag...hillemanlabs
Funding from European and Developing Countries Clinical Trials Partnership (EDCTP) will allow testing of a novel whole-cell inactivated oral vaccine in clinical trials in Europe and Africa.
Global Medical Cures™ | National Strategy for Combating Antibiotic Resistant ...Global Medical Cures™
Global Medical Cures™ | National Strategy for Combating Antibiotic Resistant Bacteria
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Multiple health problems in elderly peoplepage 950Ex.docxgilpinleeanna
Multiple health
problems in
elderly people
page 950
Excessive
drinking in
young women
page 952
Adverse drug
reactions in
elderly people
page 956
Palliative care
beyond cancer
page 958
Drug resistant
infections in
poor countries
page 948
Management
of chronic pain
page 954
M
A
K
IN
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A
D
IF
FE
R
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945BMJ | 26 APRIL 2008 | VOLUME 336
BMJ | Making a difference | 26 april 2008 | VoluMe 336 947
Running the gauntlet to improve
patient care
This supplement is the result of a gauntlet
thrown down, and picked up, during a dinner
in London just over a year ago. The gauntlet
thrower was Don Berwick, president of the
Institute for Healthcare Improvement in Boston.
What, he asked, was the BMJ Publishing Group
really for? What were we trying to achieve? In
reply, I and our chief executive, Stella Dutton,
were quick to quote the BMJ’s mission, which
ends with the crucial words “to improve
outcomes for patients.” Fine, said Don, but how
about being more specific: which outcomes,
what patients, by how much?
We took his suggestion seriously. Why not
target a few important healthcare problems,
taking a quality improvement approach
and focusing on the evidence on how to
make a difference in these areas? But how
to choose which issues to tackle among
the many millions of pressing healthcare
challenges facing the world? We turned in the
first instance to BMJ readers. In May 2007
we asked you to tell us what information was
most needed to improve the quality of care of
patients in clinical practice. From your many
rapid responses we harvested more than 200
ideas. After categorising these and matching
them against the priorities of national and
international bodies, we created a shortlist
of 12. With the help of an expert panel (see
http://makingadifference.bmj.com) we cut
these down to six.
Inevitably the choice of topics is subjective
rather than scientific, but the six we have
ended up with are interesting. Several turn the
spotlight on areas that are less than glamorous
and are perhaps all too often passed over, even
as their impact on individual lives and society
increases. Two topics deal with problems of
old age: multiple illness and adverse drug
reactions. Two deal with palliation: of chronic
pain and in dying from non-malignant disease.
The remaining topics deal with two very
different but serious and growing public health
challenges: drug resistant infections in the
developing world and excessive drinking in
young women. You will no doubt find important
gaps in what we have chosen. But if this
initiative proves useful we can expand it further.
On each of the six topics we’ve invited
leading commentators to write the pairs
of articles that make up this supplement.
One article in each pair aims to describe
the importance of the problem in terms of
its health and societal impact. The other
looks at the available evidence on quality
improvement initiat ...
Dr. Bernadette Dunham - Building a Coalition for One Health Approach to Prese...John Blue
Building a Coalition for One Health Approach to Preserving Antibiotic Effectiveness - Dr. Bernadette Dunham, Visiting Professor, Milken Institute School of Public Health, George Washington University, from the 2016 NIAA Antibiotic Symposium - Working Together For Better Solutions, November 1 - 3, 2016, Herndon, Virginia, USA.
More presentations at http://www.swinecast.com/2016-niaa-symposium-antibiotic-use-working-together-for-better-solutions
Taking place under the tagline ‘We can. I can.’, World Cancer Day 2016-2018 will explore how everyone – as a collective or as individuals – can do their part to reduce the global burden of cancer.
Just as cancer affects everyone in different ways, all people have the power to take various actions to reduce the impact that cancer has on individuals, families and communities.
World Cancer Day is a chance to reflect on what you can do, make a pledge and take action. Whatever you choose to do ‘We can. I can.’ make a difference to the fight against cancer.
WCD2016 website http://www.worldcancerday.org/ materials http://www.worldcancerday.org/materials and ways to help http://www.worldcancerday.org/get-involved
Dr. Benjamin Park - Antimicrobial Resistance in Humans and the Global Health ...John Blue
Antimicrobial Resistance in Humans and the Global Health Security Agenda - Dr. Benjamin Park, Senior Advisor for International Healthcare Quality, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), from the 2015 NIAA Antibiotic Symposium - Stewardship: From Metrics to Management, November 3-5, 2015, Atlanta, Georgia, USA.
More presentations at http://swinecast.com/2015-niaa-symposium-antibiotics-stewardship-from-metrics-to-management
Dr. Tom Chiller - International Activities in Antimicrobial ResistanceJohn Blue
International Activities in Antimicrobial Resistance - Dr. Tom Chiller, Associate Director for Epidemiologic Science, Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
1- MarketingBefore putting the product into the market, the prod.docxmonicafrancis71118
1- Marketing
Before putting the product into the market, the product goes through several stages. One of the most important stages is to determine the price of the product. After that, it will be studied by asking questions to customers and anticipate their requirements in terms of shape, colour phrases recorded on it. It can be applied using servery or interview the customer. Finally, the product needs to be promoting before it is been released, so electronic, and visual and audio can be used as advertising. However, in this experiment, we will focus only on the total cost of the product and then work on finding who develops the product….[9] [10].
1.1 Estimating of the total price.
For the antibiotic spray, it can be estimate the total price depend on the type of the material which were be used. Thus, the material in the table estimates the total price.
Material
Discerption
Brand/ manufacture
Price Ink VAT.
[1] Cefuroxime(as Cefuroxime sodium) 1.5 gram.
CEFUROXIME is a cephalosporin antibiotic. It is used to treat certain kinds of bacterial infections. It will not work for colds, flu, or other viral infections
£4.70
[2] Sterile Water (1000ml)
Single Bottle of Sterile Water (1000ml)
Baxter
£3.54
[3] 73.5 mg of sodium
Sodium Bicarbonate 2kg - Pharmaceutical Grade (Bicarb/Bicarbonate of Soda)
£6.49
[1] Metronidazole
Metronidazole 500mg/100ml infusion 100ml bags (A A H Pharmaceuticals Ltd)
£63.86
[4] Phosphatebuffer (pKa=7.2)
PBS405.1 Virtual PHOSPHATE BUFFERED SALINE pH 7.4 10X Liquid Concentrate, 1L
£22.75
[5] Brilliant Blue FCF
1 kilogram
£6-8
[6] 100ml Stainless Steel
Empty stainless bottle spray
£7-9
Total price
£118
2- Companies and industry
There are many companies interested to work on or collaborate for developing the antibiotic. Following, there are some of the companies, Charities and universities, which they work hardly to improve public health and more specifically in the development of antibiotics. Thus, the product will be a focuses for them and new idea that can be started to develop and prove its effectiveness. Then, it can be put in the market, which many people can take advantage of the ease and licences of the product.
2.1. GSK Company [13]
At GSK, they are at the forefront of researching new ways to tackle some of the world’s biggest healthcare challenges. So as antibiotic resistance grows, they are investing in new ways to fight infection.
Their approach is to make the most of their own expertise and experience, while at the same time forming complementary partnerships and alliances with others who bring different kinds of expertise. Their vision for the world, where everyone has access to the vaccines they need, depends on a steady supply of great ideas and brilliant science. They have much to offer and through collaboration, they can achieve so much more.
For example, more than 90% of the vaccines in their pipeline are being developed in partnership with others. They have a long track rec.
Feasibility of an SMS intervention to deliver tuberculosis testing results in...SystemOne
Pre-treatment loss to follow-up is common for patients diagnosed with tuberculosis (TB) in high-burden countries. Delivering test results by SMS is increasingly being considered as a solution, but there is limited information about its feasibility as a public health tool in low resourced settings. It was found that reporting Xpert results via automated SMS is technically feasible and results in approximately half of patients receiving their test results immediately. Additional research should be done to address process inefficiencies in order to maximize impact of this technology and link its successful utilization to improved patient outcomes.
The Role of Connected Diagnostics in Strengthening Regional, National and Con...SystemOne
Although numerous disease intelligence and surveillance systems exist, they are plagued with inaccurate or untimely data. We contend, furthermore, that it was this lack of data quality – and not
the lack of surveillance systems or networks – that prevented the global community from acting earlier in response to the Ebola outbreak in 2014–2016. The new field of ‘connected diagnostics’ is one solution to this concern, as it automates data collection directly from the diagnostic instruments to multiple levels of stakeholders for real-time decision-making and policy response.
This article details how the intervention of ‘connected diagnostics’ could solve the primary underlying failure in existing surveillance systems – the lack of accurate and timely data – to enable
difficult political decisions earlier. The use of connectivity solutions can enable critical health and operational data to empower the Africa CDC, regional hubs, and each country with a consistent
and automated data feed while still maintaining country privacy and controls.
GxAlert for Real-time Management and Strengthening of Remote GeneXpert Networ...SystemOne
Real-time monitoring of GeneXpert machines can contribute to reduced error rates and shorter turnaround
times for module replacement and can improve the overall
maintenance of the machines. Emails and SMS alerts can speed
up treatment initiation. The NTP now gets SMS alerts and emails for DR-TB patient enrollment; stockout and error (>5%) rates; critical module errors; and monthly MDR reports to ensure better
connections among diagnosis, enrollment, and treatment.
Racing for results: lessons learnt in improving the efficiency of HIV VL and ...SystemOne
In pursuit of the 90–90–90 goals, emphasis has been placed on accelerating centralized laboratory HIV viral load testing of a population that is largely rural and decentralized. Successful
outcome requires effective specimen transport, laboratory testing, and results delivery. This paper focuses on the methods currently employed for results delivery. New innovations in this area are
yielding mixed results; we analyze different approaches and estimate the impact of each on achieving the third ‘90.’
GxAlert Papua New Guinea Case Study 072518SystemOne
GxAlert's use in Papua New Guinea for disease surveillance and response. Initially used for Tuberculosis response, device management and second-line drug forecasting and stockage.
Bangladesh case study on how we implemented a connected diagnostics solution using GxAlert for infectious disease surveillance, TB program optimization and leveraging diagnostic data.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. ABOUT FIND
FIND was founded in 2003 to bridge existing
development gaps for essential diagnostics by
initiating and coordinating research and development
(R&D) projects in collaboration with the international
research community, the public sector and the in vitro
diagnostics industry. Today, FIND is a leading partner
across the value chain of diagnostics development
and delivery. We have programmes in tuberculosis
and acute febrile respiratory infections, malaria and
acute febrile syndrome, hepatitis C and neglected
tropical diseases. We also have mini-portfolios in
areas affecting reproductive and child health: HIV;
sexually transmitted infections; and infections and
nutritional deficiencies in children less than five
years of age. At FIND, we envision a world where
diagnostics guide the way to health for all people. We
aim to turn complex diagnostic challenges into simple
solutions to transform lives and overcome diseases
of poverty. To do this we focus on four strategic goals
throughout all the disease areas in which we work:
Catalyse
development
Accelerate
access
Guide use
& policy
Shape
the agenda
Identify needed diagnostic solutions and
remove barriers to their development
Support uptake and appropriate use of
diagnostics to achieve health impact
Lead products through the clinical trials pathway to
global policy on use and market entry
Improve understanding of the value of
diagnostics and strengthen commitment
to their funding and use
FIND’s
Vision
FIND’s
Mission
A world where diagnosis guides the way
to health for all people
Turning complex diagnostic challenges
into simple solutions to overcome
diseases of poverty and transform lives
3. “This is a global problem requiring multiple solutions – and
accessible, accurate, and affordable diagnostics play a vital role in
protecting our antibiotics and for surveillance in humans, animals,
and the environment. I am pleased that organisations such as
FIND are not only focusing on developing new diagnostics but
also implementing existing ones in all parts of the world. Global
leaders have recognised the importance of addressing antimicrobial
resistance – but now it is time to act.”
Professor Dame Sally Davies, UK Chief Medical Officer, IACG on
AMR co-convener
“...this is an issue of crucial importance for the entire human race
– for people in developed and less developed countries alike. We
must ensure that existing antibiotics remain effective, and that they
are used only when medically necessary ...”
Statement by Federal Chancellor Angela Merkel at the 68th session
of the WHO World Health Assembly in Geneva, 18 May 2015
“Antimicrobial resistance is a global health emergency that will
seriously jeopardize progress in modern medicine. There is an
urgent need for more investment in research and development,
otherwise we will be forced back to a time when people feared
common infections...”
Tedros Adhanom, Director-General, WHO, Call to Action on
AMR, 17 October 2017
4. Antibiotics first entered common use in the 1950s,
rightly perceived as wonder drugs as they truly
transformed human and animal health. Today,
their use has become ubiquitous and societies
and economies are reaping the benefits. But
bacteria, parasites and viruses are smarter than us.
It is now clear that these pathogens will naturally
evolve resistance to all our treatments. It is not an
understatement to say that that could be catastrophic
for humankind, as decades of medical progress are
on the brink of being wiped out.
Action is not optional, and diagnosis is an essential
weapon in our fight against antimicrobial resistance
(AMR). It shocks me that the way in which we make
prescribing decisions today hasn’t fundamentally
changed since the 1950s. There are many reasons
for this, including a lack of good and rapid tests to
confirm the judgement of the doctor, and the cost of
such tests exceeding the price of the drugs, leading
to “just in case” prescribing.
We need to stop treating antibiotics like candy. Yes,
we need to ensure – especially in low- and middle-
income countries – that everyone, humans and
animals alike, get the appropriate drugs when they
are really needed. But we need to stop behaving as
though antibiotics are the miracle cure for virtually
anything: from humans feeling a little under the
weather, to fattening animals faster in order to
increase farming productivity.
I had the pleasure of leading the 2016 Review
into Antimicrobial Resistance1
, which identified
interventions to address AMR that can boost supply
of new treatments, for example by incentivizing
research and development, and reduce demand
for current treatments by decreasing unnecessary
prescribing. Perhaps my single favourite of all the
demand-reducing interventions focuses on two really
powerful recommendations concerning diagnostics.
First, we believe the Market Entry Awards that we
proposed to stimulate the development of new
antibiotics should be equally applicable to state-
of-the-art diagnostic techniques. Second, we
recommended that the richest countries, including
all the G7 countries, should mandate into law that a
validated diagnostic assay demonstrating the need
for antibiotic therapy must be used prior to writing
a prescription. Without such a big, bold step, it is
unlikely that rapid progress can be made to reduce
the scale of inappropriate use and limit the rapid
emergence of resistance to our available drugs.
I thoroughly welcome the initiatives and strategies
that FIND is proposing for the development and
introduction of diagnostics to reduce the overuse
of antibiotics and ensure that new drugs will remain
effective for as long as possible. In the context of our
Review’s findings and recommendations, I believe
these steps will move us in the right direction of
reducing the scale of AMR globally.
FOREWORD BY JIM O’NEILL
1. Jim O’Neill (Review chairman). Tackling drug-resistant infections globally: final report and recommendations; the review on antimicrobial
resistance. May 2016. https://amr-review.org
5. 3
AMR
ARLG
BARDA
CARB-X
CDC
DNA
EU
FAO
FIND
GAMRIF
GARD-P
GLASS
HIV
IACG
ICU
JPIAMR
LMICs
LRTI
MDR-TB
MRSA
NIH
OECD
OIE
R&D
ReAct
ReSeq
SDG
STI
TB
TTP
UNICEF
USAID
UTI
WEF
WHA
WHO
XDR-TB
Anti-microbial resistance
Antibacterial Resistance Leadership Group
United States Biomedical Advanced Research and Development Authority
Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator
United States Centers for Disease Control and Prevention
Deoxyribonucleic acid
European Union
Food and Agriculture Organization of the United Nations
Foundation for Innovative New Diagnostics
Global Antimicrobial Resistance Research Innovation Fund
Global Antibiotic Research and Development Partnership
Global Antimicrobial Resistance Surveillance System
Human Immunodeficiency Virus
Inter-Agency Consultative Group
Intensive care unit
Joint Programming Initiative on Antimicrobial Resistance
Low- and middle-income countries
Lower respiratory tract infection
Multidrug-resistant tuberculosis
Methicillin-resistant Staphylococcus aureus
National Institutes of Health
Organisation for Economic Co-operation and Development
World Organisation for Animal Health
Research and development
Action on Antibiotic Resistance
Relational Sequencing data platform
United Nations Sustainable Development Goal
Sexually transmitted infection
Tuberculosis
Target product profile
United Nations Children’s Fund
United States Agency for International Development
Urinary tract infection
World Economic Forum
World Health Assembly
World Health Organization
Extensively drug-resistant tuberculosis
ABBREVIATIONS
6. ACCELERATING DIAGNOSTICS USE TO PREVENT AMR4
The inappropriate use of antibiotics and other
medicines is fuelling the emergence of antimicrobial
resistance (AMR) globally, and is reducing the
effectiveness of the few treatment options we have
left to treat severe bacterial illnesses. Currently,
700,000 deaths annually are due to drug-resistant
strains of common bacterial infections, HIV and
malaria and it is estimated that by 2050, 10 million
deaths will be caused by AMR each year. Combatting
AMR is crucial to achieve the United Nations
Sustainable Development Goals (SDGs). Diagnostics
are recognized as having a key role in both the Global
Action Plan on Antimicrobial Resistance (WHO) and
the AMR Framework for Action supported by the
IACG. Diagnosis as the ‘first prescription’ has proved
its ability to reinforce antimicrobials as a ’global good’,
to ensure patient health and to promote economic
resources.
FIND’s AMR strategy is focused on halting and
preventing antimicrobial resistance to save lives by
1) optimizing use of antimicrobials; 2) preserving new
drugs; and 3) empowering surveillance efforts.
FIND will work closely with its partners to address
the main barriers to diagnostic solutions for AMR by
contributing to the development of “fit-for-purpose”
diagnostic tests, to evidence collection for policies
and guidance on use, and to improved access to
diagnostics in countries. FIND plans to build an
existing resistance portfolio in tuberculosis, malaria
and non-malarial fever, where significant progress
has been made with rapid and near-patient molecular
and immunoassays. Current open access resources,
notably specimen banks and databases, will be
expanded to accelerate AMR assay development and
regulatory approval.
To achieve these objectives, the following
interventions have been prioritized for the current
strategic period:
Optimize use of antimicrobials through
triaging tools for community-acquired
infections, such as febrile illnesses,
respiratory or urinary tract infections:
Catalyse the development, evaluate
the utility fo r low- and middle-income
countries (LMICs) and create models for
uptake of simple and rapid diagnostic
solutions, including decision aid software,
to improve rational use of antimicrobials
and optimal management of patients when
they first present.
Preserve new drugs through companion
diagnostics for new antibiotics:
Support the development and use of
complementary rapid diagnostics,
starting with those for gonorrhea, to
prevent overuse and early emergence of
resistance.
Enable national and global surveillance
through fully-interconnected diagnostic
networks: Provide connectivity and data
interpretation to attain the full value of
diagnostic data for patients and systems
management, and deliver real-time
surveillance based on routine hospital and
community data.
The ultimate impact of FIND’s work will depend on
the uptake of such diagnostic solutions. As there
is currently no established mechanism to drive
access to innovation in LMICs, FIND will strongly
advocate and seek partners for the creation of an
AMR Diagnostics Use Accelerator that could create
a pull mechanism for further R&D investment. LMICs
carry the highest AMR burden, so global impact can
only be achieved by targeting these populations and
investing in diagnostic services that are scalable in
these settings.
1
2
3
EXECUTIVE SUMMARY
7. 5
The inappropriate use of antibiotics and other
medicines is fuelling the emergence of antimicrobial
resistance (AMR) globally, and is reducing the
effectiveness of the few treatment options we have
left to treat severe bacterial illnesses. Currently,
700,000 deaths annually are due to drug-resistant
strains of common bacterial infections, HIV and
malaria and it is estimated that by 2050, 10 million
deaths will be caused by AMR each year – with a loss
of over 100 trillion USD in economic output2
. In 2015
alone there were almost 500,000 new cases of multi-
drug resistant tuberculosis reported3
. A major cause
of neonatal deaths worldwide, sepsis is often caused
by resistant bacteria.
Addressing the spread of AMR is essential
to achieving the United Nations Sustainable
Development Goals (SDGs). In addition to good
health and well-being (SDG 3), AMR also threatens
sustainable food production (SDG 2), clean water
(SDG 6) and economic improvement (SDG 1 and 8).
AMR does not discriminate. The most vulnerable
populations are most at risk for contracting life
threatening infections. In particular, people living
in LMICs are significantly affected by high rates of
AMR, as indiscriminate use of antibiotics – a major
driver in the development of drug resistance – to
treat non-bacterial infections is common due to the
fact that doctors and health care providers often
rely on empirical evidence, even for 2nd
and 3rd
line
antibiotics, due to a lack of accessible and usable
diagnostic tests.
In the absence of appropriate diagnostics, we have
seen a 40% increase in the global consumption
of antibiotics in a single decade2
. There is a clear
observed correlation between antibiotic overuse
and resistance. In LMICs, most children with
fever and a negative malaria test are estimated to
receive antibiotics (e.g. 60-95% in a study carried in
Tanzania), while only a very small share of them would
actually need them, as the majority of these cases are
self-limited viral illnesses.
The issue of how to fight AMR has been on the global
public health agenda for some time, yet it has only
recently been raised to a crisis level, with increasing
political momentum4
and global attention5
. At the
same time there has been as a growing recognition of
the benefits that diagnostics can bring to many of the
identified core action areas2
.
2. O’Neill J. “Tackling Drug-Resistant Infections Globally: Final
Report and Recommendations”. May 2016 https://amr-review.org/
sites/default/files/160518_Final%20paper_with%20cover.pdf
3. WHO. Global Tuberculosis Report, 2017. https://amr-review.org/
4. G20 Health Ministers’ Meeting: Fighting Antimicrobial
Resistance, Berlin, 20 May 2017 http://www.oecd.org/g20/
summits/hamburg/g20-health-ministers-meeting-fighting-
antimicrobial-resistance.htm
5. AMR Framework for Action Supported by the IACG, August
2017 http://www.who.int/antimicrobial-resistance/interagency-
coordination-group/20170818_AMR_FfA_v01.pdf
AMR CHALLENGES AND OPPORTUNITIES:
GLOBAL AND LOCAL
8. ACCELERATING DIAGNOSTICS USE TO PREVENT AMR6
Saving
“the global good”
Saving
patients lives
Saving money
$
•• CRP POC testing can reduce antibiotic prescribing in general practice by
20-40%
•• Procalcitonin-guided management can reduce antibiotic prescribing in
both general practice (OR 0.10) and emergency departments (OR 0.34)
•• Rapid molecular diagnostics can reduce the time to pathogen identification
•• Use of blood culture diagnostics, coupled with stewardship practices, is
associated with improved times to optimal and effective antimicrobial tx, a
critical prerequisite e.g. for mortality reduction in sepsis
•• Active surveillance testing (AST) for MRSA can lead to a cost-benefit of
>$80.000/1000 patients
Diagnosis allows us to protect not just our critical
drug arsenal, but also patients who are under
threat from resistant pathogens. Diagnosis as the
‘first prescription’ has proven its ability to save
antibiotics, health and money. A number of studies
show that antibiotic use can be dramatically cut
through the use of a simple diagnostic and there
is increasing evidence that limiting overuse of
antibiotics can have positive impact on individual
patient outcomes6,7,8,9,10,11,12
. Diagnostics have been
shown to reduce the time to pathogen identification
and to optimal and effective antimicrobial treatment;
active surveillance testing can lead to significant cost
savings13,14,15
.
DIAGNOSTICS: A CRITICAL COMPONENT OF
AMR SOLUTIONS
6. Nga et al., “Point-of-care C-reactive protein testing to reduce inappropriate use of antibiotics for non-severe acute respiratory infections
in Vietnamese primary health care: a randomised controlled trial”, Lancet Glob Health, August 2016
7. Lubell et al., “Modelling the Impact and Cost-Effectiveness of Biomarker Tests as Compared with Pathogen-Specific Diagnostics in the
Management of Undifferentiated Fever in Remote Tropical Settings”, PLoS ONE, March 30, 2016
8. Lowe et al., “Targeted Antimicrobial Stewardship Intervention for Inpatients with Viral respiratory tract infections.” Open Forum Infectious
Diseases. Vol. 3. No. suppl_1. Oxford University Press, 2016.
9. “White paper on Rapid Diagnostics Technologies to Tackle Antimicrobial Resistance”, https://healthfirsteurope.eu/wp-content/
uploads/2015/05/White-Paper-on-rapid-diagnostic-technologies-to-tackle-AMR.pdf,, Health First Europe, 2017
10. Tonkin-Crine et al., “Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in
primary care: an overview of systematic reviews.” Cochrane Review
11. Conway et al., “Recurrent Urinary Tract Infections in Children – Risk factors and association with prophylactic antimicrobials”, JAMA,
2007
12. Brismar et al., “Comparative effects of clarithromycin and erythromycin on the normal intestinal microflora.” Scan. J Infect Dis 23.5
(1991); Buffie et al., “Profound alterations of intestinal microbiota following a single dose of clindamycin.” Infect Immun 80.1 (2012); Sekirov,
Inna, et al., “Antibiotic-induced perturbations of the intestinal microbiota alter host susceptibility to enteric infection.” Infect Immun 76.10
(2008); Teo et al., “The infant naso-pharyngeal microbiome impacts severity of lower respiratory infection and risk of asthma development.”
Cell Host Microbe 17.5 (2015); Boursi et al., “The effect of past antibiotic exposure on diabetes risk.” Eur J Endocrin 172.6 (2015).
13. Banerjee et al., “Randomized trial of rapid multiplex polymerase chain reaction-based blood culture identification and susceptibility
testing. Clin Infect Dis 2015;61:1071
14. Messacar et al., “Clinical Impact and Provider Acceptability of Real-Time Antimicrobial Stewardship Decision Support for Rapid
Diagnostics in Children With Positive Blood Culture Results”, J Pediatric Infect Dis Soc, 2016
15. Peterson et al., “Methicillin-Resistant Staphylococcus aureus Control in the 21st Century: Laboratory Involvement Affecting Disease
Impact and Economic Benefit from Large Population Studies.” J Clin Microbiol, 2016
Figure 1: Diagnosis as the first prescription.
9. 7
The overuse of antibiotics is often linked to their use
in treating non-bacterial infections, predominantly
when patients present with generalized symptoms
such as acute fever, lower respiratory tract
infections, urinary tract infections, sexually
transmitted infections or diarrhoea. A U.S. study
showed that two-thirds of the 40 million people who
are given antibiotics for respiratory issues annually
receive them unnecessarily16
.
Diagnosis enables the rapid selection of the most
appropriate therapy. It can also reduce the length
of time a patient may be treated empirically, either
with ineffective or unnecessary antimicrobials.
Rapid susceptibility diagnosis allows for prompt
escalation or de-escalation of antibiotic therapy,
and switches between first-, second- and third-line
treatment options. For example, the use of blood
culture diagnosis is associated with improved time
to optimal and effective antimicrobial therapy and
a decrease in unnecessary antimicrobial use in
children . In addition, given the substantial problems
around antibiotic quality, national quality assurance
programmes that are equipped with the right
technologies can detect counterfeit or sub-standard
antibiotics.
The public health benefit of reducing the
inappropriate use of antibiotics is directly linked
to reducing the selective pressure that drives the
emergence of resistance.
Stewardship of current and new antibiotics is
paramount to ensuring they retain their efficacy for
as long as possible, especially for critically needed
treatments, e.g., for gram-negative bacteria like
N. gonorrhoea. Resistance will naturally emerge to
any new drug but the early introduction of a gating
diagnostic will ensure that these drugs are used
appropriately, shielding them from rapid overuse and
early emergence of resistance. This protection of
new drugs should slow the emergence of resistance
and preserve this global resource.
Connected surveillance tools to track and map
emergence, geographical patterns and range
across pathogens of resistance are the basis of
national and global surveillance programmes such
as the Global Antimicrobial Resistance Surveillance
System. They enable appropriate control measures
at local, national and global levels, as well as
improved treatment strategies. Screening and
isolation of infected patients help prevent the spread
of resistant pathogens in community and hospital
settings. Sharing of information on the emergence of
resistance at the national, regional and global level
helps to set guidelines and drive prioritization of both
development and access activities.
Beyond these three critical areas, the role of
diagnostics to combat AMR is evident across every
category set out in the IACG Framework for Action
(Table 1).
Optimizing use of antimicrobials
Preserving new drugs
Empowering surveillance efforts
16. Data extracted from: Shapiro et al., “Antibiotic prescribing for adults in ambulatory care in the USA, 2007.09.” Journal of Antimicrobial
Chemotherapy, 2013
17. Messacar et al., “Clinical Impact and Provider Acceptability of Real-Time Antimicrobial Stewardship Decision Support for Rapid
Diagnostics in Children With Positive Blood Culture Results”, J Pediatric Infect Dis Soc, 2016
10. ACCELERATING DIAGNOSTICS USE TO PREVENT AMR8
Reduce
need and
unintentional
exposure
Optimize use of
medicine
Invest in
innovation,
supply and
access
Human infection prevention and
control
Identification of resistant
pathogens
Clean water and sanitation
Identification of source
contamination
Clean water and sanitation
Identification of resistance;
surveillance of zoonotic
transmission events
Food safety Identification of contaminants
Environmental contamination Quantify antibiotics
Human use
Rapid triaging, infection and
resistance identification
Animal & agricultural use Identification of pathogens
Laboratory capacity & surveillance
Identification of pathogens and
resistance
Basic research Biomarker discovery
Development of therapeutics &
access
Efficacy measurement,
Stewartship of new therapeutics
Diagnostics development and
access
Applies to all
Vaccine development and access
Efficacy measurement, Rapid
identification for deployment
Quality Counterfeit drug detection
Table 1: Diagnostics underpin each of the IACG Framework for Action content areas.
Acknowledging the pivotal role of diagnostics in
safeguarding antibiotics as a global good, patient
lives and country resources, FIND has developed
a strategy that focuses on halting and preventing
AMR by targeting three discreet challenges:
• optimizing use of antimicrobials;
• preserving new drugs; and
• empowering surveillance efforts.
To achieve this, FIND will draw on its existing
operating model as well as on new initiatives in an
end-to-end effort in which product development
is complemented with work on policy initiatives
and access (Figure 2). The planned results of our
work within the next years are that antibiotic use
will be underpinned by results of simple tests that
are deployed in stewardship strategies especially
for new drugs, and are fully interconnected for
robust surveillance. While working on global R&D
solutions, we will target LMICs for access work.
Given the dynamic nature of AMR and its rapid
spread across borders, addressing the problem in
LMICs is expected to have global impact, as these
countries carry the highest AMR burden and have
the most challenging access issues.
FIND’S STRATEGY IN AMR
11. 9
FIND interviewed ~30 experts and stakeholders
to help identify priority AMR needs and barriers
outside of the vertical programmes for TB, malaria
and HIV. Aside from identifying an important need
for R&D, it was noted that, more importantly,
barriers to uptake must be lifted. In LMICs, some
diagnostics may not be in use because they are
either unavailable or too expensive for these
markets. Others have no data supporting their use
in LMICs, which further hinders their uptake and
appropriate market pricing. The low demand and
resulting low industry investment is complicated by
the lack of a global health purchasing entity, like
the Global Fund, especially given the cross-cutting
nature of AMR.
While typical LMIC market dynamics hamper
access to available diagnostics, there is a larger
problem in terms of AMR diagnostics. In nearly
all cases, it is cheaper and simpler to treat a
patient with antibiotics than to test a patient
with a diagnostic. Antibiotics are generally
unregulated and easily available. Since patients
are mostly responsible for their own health care
costs, it will be a challenge to convince them to
pay for a testing and treatment, especially when
the diagnostic part will likely be several factors
more expensive than the drugs. Compounding
this complication is the facility of providing an
antibiotic. The doctor or health care provider
may feel they have provided good care by giving
antibiotics and the patient in turn feels well cared
for. This is particularly important in rural settings
where patients cannot always get hold of medical
advice and where follow-up visits may not be
feasible even in the case of increasing severity.
FIND’s strategic activities aim to respond to the
main identified barriers that affect the impact of
diagnostic solutions (Figure 3).
Optimized
antimicrobial use
New drugs
preserved
Surveillance efforts
empowered
Simple tools for community-
acquired infections inform
antibiotic use
Companion diagnostics
for new antibiotics used in
stewartship strategies
Fully-interconnected
diagnostic networks enable
real-time surveillance
Figure 2: FIND’s strategy to achieve impact in AMR.
Saving “the global good”
Saving patients lives
Saving money$
IMPACT
Outcomes
1
1
2
2
3
3
Outputs
1
2
3
Inputs
End-to-end approach,
from R&D for “fit-for-
purpose” diagnostics
to evidence for
policy to Models for
successful country
introduction
Established
programmatic
expertise (e.g. TB,
fever) and practice (e.g.
WHO alignment)
Innovative partnering
and funding initiatives
such as the “Dx Use
Accelerator”
12. ACCELERATING DIAGNOSTICS USE TO PREVENT AMR10
To date, FIND’s work in AMR has focused on
tuberculosis, malaria and Fever; notably the
development, evaluation and introduction of rapid
molecular and sequencing-based solutions for drug
susceptibility testing and point–of-care triaging tools.
By analysing the patient pathway and the diagnostic
information that is needed at different levels of the
health system, we narrowed down eight priority
interventions and ranked them in terms of short-term
action (Figure 4).
PRIORITY INTERVENTIONS FOR IMPACT
Development
of“fit-for-purpose”
diagnostics
Develop prioritized
diagnostics strategies with
WHO
Create supporting services
e.g. virtual bio-repositories,
sequencing databases
Steward R&D pipeline for
prioritized needs
Evidence for policies
& guidance on use
Provide evidence on new
tests for WHO-prioritized
needs
Expand ReSeq TB database
for sequencing-based
surveillance
Develop decision aid
package combining
algorithms, software and
simple diagnostics
Country introduction
& scaled access
Understand markets and
motivators for behaviour
change
Apply connectivity
learnings to AMR for
patient management and
surveillance
Define and implement
replicable diagnostic service
delivery models
Ecosystems change
Raise awareness for the value of diagnostics
(e.g. through specific campaigns; AMR score card, etc.)
Mobilize finance and procurement mechanisms for market sustainability
Figure 3: Solutions across the value chain to address barriers limiting access to and use of diagnostics.
13. 11
Figure 4: Preliminary prioritization of needs (1 = highest priority, stars indicating areas of near term focus) based
on existing and relevant tools to address identified scenarios.
Figure 5: Three priority diagnostic interventions to contribute to WHO Global Action Plan
Identified
scenarios
Key needs Diagnostic
readiness
Impact:
Antibiotic
use
Impact:
Lives
saved
Role for
FIND
R&D
Policy &
Access
1. Fever and/or
LRTIs
R&D: develop triaging tools
Pol. & Acc.: Evaluate dx packages: e.g.,
CRP; Procalcetonin; CBC; mol panels
+++ ++++ +++ +++ 1 1
2. UTIs
Pol. & Acc.: Evaluate urinary dipsticks
and define route-to-market
++++ ++++ + +++ 3 1
3. Diarrhoea
Pol. & Acc.: evaluate rota/ adenovirus
RDTs, multiplex molecular test
+++ +++ ++ +++ 3 3
4. New-borns with
suspected severe
infection
R&D: tbd
Pol. & Acc.: evaluate procalcetonin;
Blood culture; CBC; oximeters
+ ++++ ++++ + 2 2
5. STIs
R&D: improve gonorrhoea DST, new
RDTs and multiplex molecular tests
Pol. & Acc.: define route-to-market
++ ++ ++ ++ 1 2
6. Quality Diagno-
stics to identify
counterfeits
R&D: tbd
Pol. & Acc.: evaluate Minilab, CD3,
Raman/NIR
+ +++ +++ +++ 2 2
7. Patients with resi-
stant pathogens
Pol. & Acc.: evaluate molecular screening
of swabs or isolates
++ +++ ++ ++ 3 1
8. Surveillance data,
tools and processes
R&D: develop connectivity solutions
Pol. & Acc.: integrate existing solutions
into national surveillance
N/A ++++ ++ +++ 3 1
Taking the outcomes of the analysis and applying the findings towards our strategic objectives, FIND will
expand its existing portfolio to address the following priority needs:
Optimizing use of
antimicrobials
Triaging tools for community acquired infections such as febrile
illnesses, respiratory or urinary tract infections
Catalyse development, evaluate utility for LMICs and create models for
uptake of simple diagnostic solutions, including decision aid software,
to improve rational use of antimicrobials and optimal management of
patients when they first present
Companion diagnostics for new antibiotics:
Support the development and use of complementing diagnostics for
new antibiotics, starting with those for gonorrhea, to prevent overuse
and early emergence of resistance.
Fully interconnected diagnostic networks:
Provide connectivity and data interpretation solutions to achieve the full
value of diagnostic data for patients and systems management, and to
supply real-time surveillance based on routine hospital and community
data.
Preserving new drugs
Empowering surveillance
efforts
14. ACCELERATING DIAGNOSTICS USE TO PREVENT AMR12
One of the most promising solutions for triaging
patients in the community that present with fever or
other common symptoms like cough or diarrhoea
would be a test based on host biomarker detection
to differentiate between bacterial and non-bacterial
infections. Through an extensive, publicly available
landscape analysis, FIND has identified a number
of biomarkers for fever that could be used in
rapid blood testing in low- and middle-income
countries. In 2017, FIND started a multi-centric
study to evaluate the performances of potential
new biomarkers to differentiate bacterial from
non-bacterial febrile illnesses of outpatients from
hospitals in three countries.
To prevent the use of unnecessary antibiotics, FIND
plans to expand this triaging programme to evaluate
the utility of simple triaging tools (e.g. UTI dipsticks,
electronic health algorithms), redesign or adapt them
for LMIC needs and develop models for uptake to
optimize the use of antimicrobials.
FIND aims to support the continued efficacy of
new antimicrobials. An initial priority could be the
development of diagnostics to improve better rapid
gonorrhoea tests and resistance testing to enable
a definitive diagnosis prior to treating patients with
new antibiotics that are currently in development.
These tests will ensure that only patients with
gonorrhoea or drug-resistant gonorrhoea receive
the new treatment, thereby preventing overuse and
early emergence of resistance. It is estimated that
introducing a point-of-care rapid test for gonorrhoea
could significantly reduce the use of ceftriaxone and
shorten the mean time to treatment by 2.3 days18
.
Ensuring connectivity, i.e., linking diagnostic tests
with communications technology, allows for better
management of health data and maximizes the
health impact of the tests. Connectivity solutions
help strengthen the link between patient diagnosis
and treatment. The real-time transmission of geo-
tagged test results to national health information
systems means that potential AMR cases can
be addressed immediately, allowing for a rapid
response. FIND plans to establish connectivity for
AMR diagnostics and decision aid tools, thereby
extending the reach of national surveillance
programmes to include routine hospital and
community data. In addition, remote monitoring can
improve supply chain management and forecasting
and enhance diagnostic device quality assurance.
Triaging tools for community acquired infections
Companion diagnostics for new antibiotics
Data utilization for clinical decision-making and surveillance
18. A study conducted in Tanzania among acute febrile children shows that 70.5% of the children had a viral disease, 22.0% had a
bacterial disease and 10.9% had a parasitic disease.
15. 13
FIND works as a bridge between experts in
technology development, policy, and clinical care
and has active collaborations with over 200 partners.
FIND will work closely with WHO to support the
development of TPPs, provide input on policy
recommendations and guidelines and inform
global surveillance efforts. Diagnostics are usually
a minor component of existing initiatives such as
CARB-X, JPIAMR, NIH, BARDA, Bill & Melinda
Gates Foundation, and ARLG and there is currently
no mechanism that supports interventions to drive
uptake of existing and new diagnostics to combat
AMR. FIND will i) collaborate with existing and new
partners to support an integrated response to AMR
(Figure 6); ii) advocate for the creation of an AMR
Diagnostics Use Accelerator to establish a smooth
pathway to uptake of diagnostics in LMICs; and
iii) create a pull mechanism for R&D investment by
creating market predictability. Through an Accelerator,
cross-cutting issues such as market and pricing
interventions; procurement mechanisms; policy
change; information, education and communication
for behaviour change and civil society engagement;
and knowledge management could be most
appropriately and usefully addressed.
OPERATING MODEL
OTHERS
•• Establish an AMR
Diagnostics Use Accelerator
•• Develop
companion
diagnostics,
starting with
gonorrhoea
•• Inform diagnostic priorities
with LMIC perspective
Discussion initiated
Identified prospect
•• Share experience and
data on diagnostics
needs and impact
•• Support
evaluation
and uptake
of diagnostic
solutions
Figure 6: FIND’s role in possible collaborations with key partners in the AMR response.
16. ACCELERATING DIAGNOSTICS USE TO PREVENT AMR14
Results and impact of the different interventions
will be monitored through robust and standardized
processes, and results widely disseminated through
partnering networks and other channels.
A step-change in diagnostic use is possible, as has
been demonstrated for malaria and HIV where we
have seen a rapid transformation of the diagnostics
landscape in LMICs within a decade. Change
for AMR will rely on strong partnerships and
coordination. Funding for scalable and innovative
interventions to overcome barriers and accelerate
diagnostic impacts is critical.
In combination, our priority interventions will
save global goods by prolonging the life span of
existing diagnostics, save health by ensuring better
and timelier treatment, and save money both by
reducing the use of antibiotics and the health
impact of antibiotic resistance.
FIND recognizes the burden caused by drug
resistant TB, HIV and malaria, and their role in
contributing to the global AMR challenge. However,
the focus of this investment case will specifically
be on pathogens and syndromes not already
addressed in existing programmes.
FIND’s AMR strategy will require a funding
commitment of ~$72M to drive the work divided
into three phases spanning the first six years, while
expecting a 10-year programme lifecycle (additional
funding to be identified in the later phases). Phases
have been structured so that key deliverables must
be completed to allow for next phase prioritization
and maturation of the initiative. Support for the
WHO’s Essential Diagnostics List will be a priority
during Phase 1 and Phase 2 to ensure alignment
and clarity on priorities.
Phase 1 will focus on establishing the key
partnerships and aligning on priorities in AMR
beyond fever. Market understanding on the
impact of diagnostics in AMR will be established
and priority activities will be implemented across
development, policy, and access. An R&D portfolio
will be built for at least two priority target product
profiles. Prioritized clinical scenarios, publication
of landscapes and TPPs, and establishing a
virtual sample bank and a decision-aid package
combining algorithms, software and simple
diagnostics will demonstrate early impact. Multi-
centre studies will be conducted to demonstrate
impact of at least three triaging tools. Study data
and support for the WHO Essential Diagnostics List
will inform priorities for Phase 2 as the work begins
to expand.
INVESTMENT NEED
Phase 1: Launch of AMR Strategy Years: 2018 - 2019 Funding Commitment: $17M
17. 15
FIND’s fever programme, which includes some of the targeted activities here, is well underway, and
broader TPP and landscaping work has started. Establishing and operationalizing partnerships will be
among the initial priorities. Please reach out to catharina.boehme@finddx.org and cassandra.kelly@
finddx.org if you are interested in partnering with us on this important programme.
Phase 3 will continue to mature R&D portfolios
and deliver three new diagnostic solutions while
intensifying activities and in-country demonstrations
to drive policy change, and to ensure uptake
and adoption of game-changing diagnostics.
The work started in Phase 1, and continued in
Phase 2, around the establishment of a virtual
sample bank will be matured to enable the
development of emerging technologies. Definition
and demonstration of additional replicable service
delivery models in at least three countries will
ensure impact of the developed solutions. New
initiatives and opportunities will be clearly defined
to inform how the strategy should evolve into Phase
4 to support the global needs in AMR.
NEXT STEPS
Phase 2: Implement & Expand
Phase 3: Continue at scale
Years: 2020 - 2021
Years: 2022 - 2023
Funding Commitment: $30M
Funding Commitment: $25M
n Phase 2, the strategy will mature into established
pipelines encompassing existing and emerging
tools with investments into an expanded
R&D portfolio, including two new priorities.
Demonstration studies for at least four emerging
diagnostic tools will demonstrate impact. Focus
on expanding the ReSeq database to standardize
resistance profiles for pathogens beyond TB will
support global development and surveillance
efforts in the fight against AMR. At least two
replicable service delivery models will be defined
and implemented across three to five countries to
ensure uptake of solutions. In-country champion
networks will be established to facilitate change
at the local and national levels and ensure a
sustainable hand-off of projects once they are
completed. Connectivity solutions will be linked to
AMR to facilitate local-to-global communication,
data sharing and response to AMR.