A decision support system developed by a medical research team based at Leeds and York NHS Trusts (UK) could pave the way for more predictable and less burdensome treatment of patients undergoing treatment for kidney-failure anaemia.

The computer based system, which has been commercialised as 'AMIE Renal' by University of Leeds subsidiary company Media Innovations, was successfully used to ensure the predictable outcome of treatment for anaemia in kidney patients in a study that compared the efficacy of two different medications.

Key treatments for renal-failure anaemia, which aim to stabilise haemoglobin and iron levels necessary for rehabilitation on dialysis, are Darbepoetin, which can be administered on a weekly basis, and Erythropoietin. Erythropoietin has a shorter half-life and is traditionally administered three times per week, although treatment frequency can be extended so that it too can be administered on a weekly basis, which could make treatment more convenient for patients and clinical staff.

An added issue is that both Darbepoetin and Erythropoietin are very expensive and clinicians must be careful not to over prescribe. Over prescription is a clear drain on hospital and NHS finances. To be able to reduce treatment frequency in controlled circumstances would provide clear benefits for all parties.

The randomised study, published recently in the Journal of the American Society of Nephrology, aimed to compare the clinical and organisational outcomes of treating patients on a weekly basis with either Darbepoetin or Erythropoietin. The study used a structured, computerised, advisory system, on which the AMIE system is based. It was used to control the doses of both Darbepoetin and Erythropoietin administered during the nine-month study, to a stable treatment outcome. This allowed a safe and effective comparison of the two agents to take place.

Eric Will, Consultant Renal Physician at St James' University Hospital, Leeds is one of the team behind the AMIE system and a co-author of the recent study. He said: "The use of the AMIE Renal software provides clear benefits as it standardises the way in which doses are prescribed to patients and the results of treatment. In the case of this randomised, controlled study, using our system enabled us to gain reliable clinical evidence of a difference between the two agents, something that could only be done when the outcome of treatment was predictable and similar in each treatment group."

He continued: "Traditionally, dosages have been calculated manually, which is time consuming and leaves such margins for error in the results that only stable patients can be investigated. The results of this particular study should be valid for any group of dialysis patients, regardless of their stability and characteristics. It provides yet more evidence for the effective use of the system in routine clinical practice."

Eric Will, Consultant Renal Physician, St James' University Hospital

Stephen Taylor-Parker, Managing Director, Media Innovations

Please note: enquiries about the AMIE Renal system should be directed to Media Innovations Ltd.

1. Structured Conversion from Thrice Weekly to Weekly Erythropoietic Regimens Using a Computerised Decision Support System: A Randomized Clinical Study was published in the Journal of the American Society of Nephrology in March 2005. The study was executed and authored by Cae Tolman, Donald Richardson, Cherry Bartlett and Eric Will from St James's University Hospital, Leeds and York Hospitals NHS Trust, York. The study focused on a direct comparison of two available treatment agents, Darbepoetin and Erythropoietin-beta, administered on a weekly basis, following conversion from a thrice-weekly regime.

2. The AMIE Renal decision support system is based on a careful theoretical analysis of clinical intervention, together with innovative randomised studies and reproduces the software used by Leeds and York NHS Trusts for the past eight years for renal anaemia management. It combines clinical and organisational variables in order to meet desirable treatment outcomes, providing clinicians with easy to access dosage information for each individual.

3. Media Innovations is a subsidiary company of the University of Leeds in the UK. Media Innovations is a leading provider of multimedia training materials across a wide range of industry and professional sectors. The company is also a significant developer of Training Systems, Risk Management and Diagnostic Support Tools to the medical profession. Multimedia-based products are powerful communication tools, which stimulate the senses of hearing, vision, and touch by delivering a rich combination of media components in an interactive software environment.

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SOURCE: alphagalileo

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