pronurse

"Brain Scan Test for Adult Autism"

Wed, 11 Aug 2010 00:43:50 +0200

HMForces.co.uk - What Does it Offer You?

HMForces.co.uk — Wed, 28 Jul 2010 12:05:00 +0200

HMForces.co.uk was officially launched on 15th October 2008.

It's a new online space designed exclusively for the UK military and naval community: The British Army, The Royal Navy, The Royal Marines and The Royal Air Force, to connect and develop their careers.

However, if you're also civilian and have a member of your family in the armed forces, are a spouse or a friend or have a general interest, then there's lots of info available on this site for you too.

So, What’s The Score?

Do you need advice on landing a great civilian job once you leave the Forces? Curious if you’re claiming all the benefits you’re entitled to receive?

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Or, just want to banter about which Service really works the hardest? Or want to taste the nostalgia of the old days?

This site isn't just about the serving folk but the ones who have already served in whatever service. *In addition, if you're civilian you can find a lot of advice and jokes about the life that you're comtemplating joining - and it is a different life make no mistake.*

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AND IF THAT'S NOT ENOUGH FOR YOU THERE'S "QUIZZIES":/training/quizzes AND "MIND GAMES":/training/articles/list?article_search[category_id]=294-test-your-mind AND A "SHOP":/news/articles/569-the-hmforcescouk-book-shop-is-open-all-hours FOR YOUR INTELLECTUAL SIDE (but if you can't be bothered with your intellectual side there's some daft games "here":/discussions/263-games-teasers-just-for-a-laugh/topics)

However, since the site will always be a work in progress and as it is entirely about and for members of the Armed Forces – your feedback is crucial.

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Please drop us a line if you have an idea for a new feature, want us to investigate something, or even if you’ve found a broken link.

Thanks!

Stewart Thompson

General Manager

The Real Lessons Of This NHS Disaster

The Independent — Tue, 20 Jul 2010 10:52:00 +0200

The Health Secretary, Andy Burnham, yesterday described the appalling treatment of patients at Stafford hospital as "ultimately a local failure". This misses the point. For one thing, Stafford is not the only NHS hospital that has put patients' lives at risk in recent years. Basildon and Colchester hospitals were also discovered to have jeopardised safety in 2009.

What is more, Mr Burnham's efforts to quarantine this disaster suggest an unwillingness to face up to the scale of the problem that has been revealed. The failure in Stafford is not just the tale of one badly run hospital, but the failure of a regulatory system that did little to sound the alarm until very late in the day. From 2005 to 2008 Stafford hospital was judged by regulators and the Government to be performing well. It passed many inspections and the Mid Staffordshire NHS Trust even achieved foundation status, supposedly the benchmark of excellence.

Yet as yesterday's independent report on Stafford by Robert Francis QC outlines, the hospital was, during this time, drastically cutting staffing budgets and leaving patients to fester in soiled sheets. How did the inspectors miss this? The report says the hospital's management was pre-occupied with cost-cutting and meeting crude targets set by Whitehall. But so too, it would seem, were the regulators. The trust appears to have been judged on the quality of its balance sheet rather than the quality of care offered to patients.

The regulators not only turned a blind eye to the cost cuts, they seem to have rewarded the Trust for it. It is true that the Healthcare Commission, did, in the end, sound the alarm over Stafford after being alerted to higher than usual death rates. But that does not excuse the fact that it - along with other monitoring bodies - missed the problem for years, during which hundreds of patients died needlessly. The NHS's regulators clearly need to overhaul their own procedures.

As for ministers, rather than attempting to present what occurred in Stafford as an isolated example of bad practice, they should examine how their own targets contributed to the distortion of care on the ground. Lessons will never be learnt while the authorities insist on burying their heads in the sand.

A service of YellowBrix, Inc.

Development of Nurse Sifting Tool

Dr Simon Draycott — Wed, 07 Jul 2010 15:27:27 +0200

The Department of Health is sponsoring the development of a new, on-line assessment tool. The tool will be available to help Higher Education Institutions select individuals on to pre-registration degree/diploma programmes, as well as to help recruit registered nurses.

Mendas Ltd, the firm of Occupational Psychologists developing it, are seeking volunteers to complete the on-line tool. No prior experience or particular knowledge of nursing is required to complete the tool.

Those completing the tool (approximately 30 mins.) will receive written feedback, the purpose of which is to provide some useful insights. Only the individual completing the tool will receive this information.

These types of tools are increasingly being used by employers in assessment and selection events. Completing this tool offers the opportunity to practice sitting such an assessment in a ‘safe’ environment.

If you want to complete the tool, click on the following link and enter the information requested. You’ll be asked to provide a sponsor code which is given below.

Once you’ve registered, you’ll receive a separate e-mail invitation to complete the tool.

Link: http://www.mendasonline.co.uk/situationsregistration

Sponsor code is: pronurse

If you have any questions, please email: nursing@mendas.com

IVF followed by Termination!!

Mon, 07 Jun 2010 14:49:37 +0200

Nurse Specialists

Fri, 04 Jun 2010 10:14:11 +0200

The Worst Hospital Scandal For 10 Years

The Independent — Thu, 25 Feb 2010 10:43:00 +0100

By Jeremy Laurance

Patients were 'routinely neglected', says most savage indictment of NHS trust How hundreds died after basic care was ignored

The worst hospital scandal in more than a decade has triggered the biggest review of safety in the NHS since the Labour government came to power.

Andy Burnham, the Health Secretary, announced an unprecedented five separate reviews of measures to protect patients yesterday, in response to an independent inquiry into failings at the Mid- Staffordshire Foundation Trust which concluded that it "routinely neglected" patients.

It is the biggest shake-up in the monitoring of the NHS since the Bristol children's heart surgery scandal of the mid-1990s, in which babies lost their lives because doctors were not being properly checked. That scandal led to the establishment of regulatory mechanisms to protect patients which the catastrophe at Mid- Staffordshire has now shown to have comprehensively failed.

Gordon Brown said the failings were "completely unacceptable". He told the Commons: "We understand both the sadness and the sorrow of all the relatives who lost loved ones in the Mid-Staffordshire hospital trust."

The report of the inquiry, chaired by Robert Francis, QC, has convulsed the Department of Health which has scrambled to produce a response that would reassure patients barely two months ahead of an election. The reviews announced by Mr Burnham yesterday will examine how the regulatory bodies failed to spot what was going wrong at Stafford hospital (to be chaired by Mr Francis), the use of death rates to highlight problems in the NHS, alleged misconduct by doctors and nurses, a new system to regulate managers (who may be "struck off" like failing doctors), and protection for whistleblowers.

In addition, more than 300 cases where patients or relatives have concerns about the treatment they received at the trust are being reviewed by independent medical panels, a number of which are expected to lead to malpractice claims.

But the measures were not enough for the Tories who demanded a full public inquiry. Andrew Lansley, the shadow Health Secretary, said patients would be worried that the Government was "still not doing all it can" to prevent a repeat of "these awful events".

Patients admitted to Stafford Hospital received care that was so lacking in the basic essentials that lives were sacrificed as a result. Mr Francis refused to put a figure on the number who had died but said it was "undeniably higher" than in other hospitals. Last March, an investigation by the NHS watchdog, the Healthcare Commission estimated there were between 400 and 1,200 excess deaths among emergency patients treated at the hospital between 2005 and 2008.

The inquiry re-iterated the earlier findings by the Healthcare Commission that patients were left lying in soiled sheets or on commodes, sometimes for hours, frightened and ashamed, as calls for help to use the bathroom were ignored. Some were left unwashed for up to a month, and others were left in pain, without drugs, and with food and drink out of reach. Staff failed to make basic observations and patients were often discharged before it was appropriate, with in at least one case alleged fatal results.

The report, which runs to 900 pages and is based on evidence from more than 900 patients and 80 current and former staff, is the most devastating indictment of an NHS organisation in memory.

There was a culture of low morale and a tolerance for poor standards fostered by a management board focused on financial targets rather than patient welfare. It persisted even after the Healthcare Commission exposed the hospital's failings last March, with some staff and managers dismissing the findings and alleging the commission had blown matters out of proportion.

In answer to one of the biggest puzzles - how staff allowed the appalling care to persist for so long - the report found those who spoke out were ignored and there was "strong evidence" that many were deterred from doing so through fear and bullying.

Accepting all the recommendations, Mr Burnham said: "This was an appalling failure at every level of the hospital to ensure patients received the care and compassion they deserved. There can be no excuses for this."

The former chairwoman of the trust, Toni Brisby, resigned last March. The former chief executive, Martin Yeates, stepped down from his post in March and resigned in May.

Under the microscope - Staffordshire inquiries

* March 2009: Healthcare Commission finds "appalling" standards of care and up to 1,200 excess deaths over three years.

* May 2009: Death rates for every hospital in England published.

* May 2009: Investigation into treatment at Mid-Staffordshire trust between 2005 and 2008 found patient complaints had been ignored.

* May 2009: Investigation into emergency care found "significant" improvements had been made.

* February 2010: Independent inquiry finds patients were "routinely neglected".

* February 2010: Five more reviews announced by the Health Secretary.

Originally published by By Jeremy Laurance HEALTH EDITOR.

A service of YellowBrix, Inc.

Mental Suffering Of One In Ten Children

Daily Mail — Wed, 24 Feb 2010 17:31:00 +0100

By Enda Feeney

One in ten children suffer mental health problems, an expert has warned.

And a further one in 50 of our under-18s will also suffer a severe and disabling condition that will merit mental health care. Colman Noctor, a child psychotherapist, said youngsters often develop conditions such as depression, eating disorders and anxiety.

'Many children can take on the worries of their parents and, in these challenging economic times, this can be especially overwhelming.

Childhood and adolescence pre-sents its own unique set of challenges to negotiate, like issues of peer pressure, identity conflict and family or relationship difficulties.

'The reality is that these challenges can have a monumental effect on a young person's developmental pathway and without robust coping skills many children and adolescents will struggle to surmount this life stage without some degree of upset,' he added, marking National Eating Disorder Awareness Week.

Dr Noctor, of St Patrick's University Hospital, in Dublin, said any parent who is concerned that a child is developing a mental health problem should monitor and observe changes in the youngster's behaviour, thinking and emotions.

'The most useful thing a parent can do to minimise the risk of mental health problems is to establish an open relationship with your child, which encourages them to come to you if something is bothering them.'

Originally published by By Enda Feeney.

A service of YellowBrix, Inc.

Obesity Fight Could Spell Death Of The Corner Shop

The Scotsman — Tue, 23 Feb 2010 15:56:00 +0100

By Craig Brown

Removing the display of sweets in shops and restricting the sale of high-calorie food near schools are among radical government proposals to make Scotland the first country in the world to successfully tackle obesity.

In a report launched yesterday, the Scottish Government said the country's obesity problem would cost taxpayers an estimated GBP 3 billion a year by 2030 if current trends continue. It revealed that Scotland currently has the fattest population after the US and Mexico from a list of 30 countries.

The Scottish Government likened its challenge "in terms of scale and complexity" to dealing with climate change.

Holyrood public health minister Shona Robison unveiled a series of proposals to work with schools, retailers, businesses and local authorities to promote healthier lifestyles.

These include restricting the sale of high-calorie foods near schools, removing sweet displays near tills and encouraging retailers to promote healthy food.

These will be backed up with legislation to force change, if necessary.

The plans promise to change the nature of the corner shop in Scotland, where confectionery and fizzy drinks are mainstays of the trade. It follows existing plans to ban the display of cigarettes.

Ms Robison said: "No country in the world has successfully addressed obesity - and we want Scotland to be the first.

"Excellent work is already under way but we have to go further and make serious changes that will transform our entire living environment.

"We plan to work across all areas of government to ensure that policies are directed at supporting people to achieve and then maintain a healthy weight."

The report, Preventing Overweight And Obesity In Scotland - A Route Map Towards Healthy Weight, revealed that in 2008 just over a quarter of adults and 15 per cent of children in Scotland were obese, and 65 per cent of adults and 31 per cent of children were overweight.

However, the strategy has come without a price tag and doubts have been cast on the effectiveness of any anti-obesity strategy without serious funding. The Scottish Retail Consortium said retailers already helped customers to choose balanced diets without the need for regulation. SRC director Ian Shearer said: "We support continuing efforts in this area but policymakers must recognise it's ultimately individuals who decide what they eat."

Tam Fry, of the National Obesity Forum and chairman of the Child Growth Foundation, said that the lack of a firm financial commitment to the strategy undermined it.

"I would have to place a question mark on the strategy because, unless that figure is impressive, I'm not awfully sure it's going to work," he said.

But Annie Anderson, professor of food choice at the University of Dundee, said : "I think suggestions like this are creative and deserve to be trialled.

"We've heard many parents complaining that they do their best for their children at home [to give healthy options], but once outside, it's difficult to give the same sort of guidance."

She added: "I think that what this report is a recognition that it is not just individuals who have a responsibility [to promote healthy living], that all sectors have responsibility, local authorities, retailers, everyone can make a contribution."

A service of YellowBrix, Inc.

Male Infertility Treatment Is Overused, Scientist Warns

The Independent — Tue, 23 Feb 2010 12:52:00 +0100

By Steve Connor

IVF CLINICS are using a radical male infertility treatment far too frequently despite the risk of long-term health problems to the babies conceived, according to one of the technique's pioneers.

Intracytoplasmic sperm injection involves injecting individual sperm cells directly into an unfertilised egg to improve the chances of producing a viable embryo which can then be implanted into the woman's womb.

Many of the medical problems associated with fertility treatment arise from more than one embryo being implanted into the womb, which brings a higher risk of multiple births and associated medical complications.

However, with injecting sperm directly into the egg, there are fears that it might increase the selection of genetically-defective sperm, resulting in problems such as heart disease, diabetes and obesity being passed on to future generations.

Andre Van Steirteghem, of the Brussels Free University Centre for Reproductive Medicine, was the leader of the team that developed ICSI nearly 20 years ago. He says that although the technique has been invaluable in treating infertile couples when the man cannot produce viable sperm for conventional IVF, it should be used only when medically necessary - and that at present many clinics routinely use ICSI even when the man can still produce enough viable sperm to fertilise an egg in an IVF test tube.

Since the first IVF baby, Louise Brown, was born in Manchester in 1978, three million children worldwide have been conceived using the technology. ICSI use has grown particularly explosively, accounting for about half of all test-tube conceptions in Britain.

Dr Van Steirteghem told the American Association for the Advancement of Science in San Diego: "I have noticed that several clinics use ICSI for everybody. I don't think it is necessary when you have methods like conventional IVF which is certainly less invasive ... When the sperm is normal, I don't see any reason why ICSI should be used.

"The health of children has to be considered the most important outcome of artificial reproductive technology treatment. It's fair to say that overall these children do well [but] there a few more problems with these children." He added: "It doesn't mean that when you use ICSI there will be more problems, but ... monitoring is extremely important."

He is monitoring the long-term health of about 15,000 children born as a result of artificial reproductive technology such as IVF and ICSI.

His views were supported by other fertility experts concerned by the growth of ICSI. "In the majority of IVF cases where you have functional and healthy sperm you shouldn't have to use ICSI," said Dolores Lamb of Baylor College of Medicine in Houston, Texas.

Originally published by By Steve Connor SCIENCE EDITOR, IN SAN DIEGO.

A service of YellowBrix, Inc.

Stop Funding Homeopathy, Report Urges

The Independent — Tue, 23 Feb 2010 10:51:00 +0100

By Jeremy Laurance

MPs say alternative medicine diverts funds from more effective treatments

The National Health Service should stop funding homeopathy, a Commons committee said yesterday.

MPs on the Commons Science and Technology Committee said there was no evidence that the complementary medicine worked. To continue funding it risked harming patients who chose ineffective homeopathic remedies in place of effective orthodox medicines, diverted NHS funds from more effective treatments and undermined the principle that government funding in health should be evidence based.

Homeopathy is based on the idea that "like cures like" and claims to use highly diluted substances to trigger the body to heal itself. Millions of pounds worth of homeopathic remedies are sold by high street chemists and are also available through the NHS, but the committee concluded they were no more effective than placebo.

Even before the report was released yesterday, the Prince's Foundation for Integrated Health responded by claiming "militant scientists" who gave evidence to the committee had "left the patient out of their calculations".

Dr Michael Dixon, medical director, admitted that homeopathy was "scientifically implausible" but said compassion and caring were being forgotten. "The task of the NHS is to improve the health of the public and to treat those who are sick or disabled. We should not abandon patients we cannot help with conventional scientific medicine. If homeopathy is getting results for those patients, then of course we should continue to use it."

The foundation called for controlled studies to compare the effectiveness and cost of homeopathy with other solutions for long- term conditions. But the Commons committee rejected the proposal on the grounds that scores of clinical trials had been conducted and failed to show a real effect (over and above placebo). Further trials could not be justified, the committee said.

Phil Willis, chair of the committee, said: "We fully understand someone taking a homeopathic remedy may feel better. But the weight of evidence showed it worked no better than placebo. If homeopathy works [better than placebo], the whole of chemistry and physics would have to be overturned. There has been enough testing."

There are four homeopathic hospitals in the UK in London, Bristol, Liverpool and Glasgow and some GP practices also offer access to homeopathic treatment on the NHS. A fifth homeopathic hospital in Tunbridge Wells, Kent, closed last year after the West Kent primary care trust withdrew funding following a review which concluded it was not cost effective.

An estimated £4m a year is spent by the NHS on homeopathy, not including the running of the hospitals.

The report criticised the licensing of products, such as Arnica Montana 30C, by the Medicines and Healthcare products Regulatory Agency which "actively misled" people into thinking it contained an active ingredient.

Originally published by By Jeremy Laurance HEALTH EDITOR.

A service of YellowBrix, Inc.

Aids: Is The End In Sight?

The Independent — Mon, 22 Feb 2010 11:42:00 +0100

By Steve Connor

Mass prescription of anti-retroviral drugs could eradicate the disease within 40 years, scientist says 'We are using drugs to save lives, not to stop transmission'

Testing everyone at risk of HIV and treating them with anti- retroviral drugs could eradicate the global epidemic within 40 years, according to the scientist at the centre of a radical new approach to fighting Aids.

An aggressive programme of prescribing anti-retroviral treatment (ART) to every person infected with HIV could stop all new infections in five years and eventually wipe out the epidemic, said Brian Williams of the South African Centre for Epidemiological Modelling and Analysis.

Dr Williams is part of a growing body of experts who believe that anti-HIV drugs are probably the best hope of preventing and even eliminating the spread of Aids, rather than waiting for the development of an effective vaccine or relying solely on people changing their sexual lifestyle.

The idea will be tested in the coming year, with the start of the first properly controlled clinical trial involving thousands of people living in a part of South Africa with a high incidence of HIV and Aids. Dr Williams said this will be followed by similar trials in the US, where HIV is rampant among some inner-city communities.

"Our immediate best hope is to use ART not only to save lives but also to reduce transmission of HIV. I believe if we used ART drugs we could effectively stop transmission of HIV within five years," Dr Williams said. "It may be possible to stop HIV transmission and halve Aids-related TB within 10 years and eliminate both infections within 40 years," he told the American Association for the Advancement of Science in San Diego, California.

Anti-retroviral drugs dramatically lower the concentration of HIV within a person's bloodstream, and, in addition to protecting patients against Aids, they significantly lower an individual's infectiousness - their ability to transmit the virus to another person.

Dr Williams and his supporters believe that if enough infected people are treated, it would lower the rate of infection to such an extent that the epidemic would die out within the lifetime of those undergoing the treatment. Aids could effectively be wiped out by the middle of this century, he said.

"The problem is that we are using the drugs to save lives, but we are not using them to stop transmission," Dr Williams said. Blocking transmission can only be done with an extensive testing regime followed by rapid treatment with anti-retroviral drugs to everyone found to be HIV positive, he said.

"The concentration of the virus drops 10,000 times [with ART] ... This probably translates into a 25-fold reduction in infectiousness. But if you did this it would be enough essentially to stop transmission," he said.

A study published in 2008 showed that it is theoretically possible to cut new HIV cases by 95 per cent, from a prevalence of 20 per 1,000 to 1 per 1,000, within 10 years of implementing a programme of universal testing and prescription of ART drugs.

"Each person with HIV infects, on average, one person every one or two years. Since people with HIV, and without treatment, live for an average of 10 years after infection, each person with HIV infects about five to 10 people," Dr Williams said. "Treating people with ART within about one year of becoming infected would reduce transmission by about 10 times. Each person with HIV would infect, on average, less than one other person and the epidemic would die out."

ART drugs have to be taken on a daily basis for life, and the cost for South Africa alone would be about $4bn (2.6bn) per year. However, Dr Williams said that the cost of having to treat a growing number of Aids patients, as well as the economic cost of young adults dying off, would be higher than giving out free ART drugs to everyone who needs them.

"The key issue of cost is that if you don't do anything it costs you a lot of money. In South Africa we spend a lot of money on people who are hospitalised with infections related to HIV," Dr Williams said. "More importantly, we are killing young adults in the prime of their life just when they should be contributing to society. The cost to society of that is enormous.

"If you factor all of the costs into the equation then, in my opinion, doing this is a cost saving from day one because the cost of the drugs will be more than outweighed by the costs of treating all of these people with other diseases," he said. "A friend of mine said that the only thing that is more expensive than doing this is not doing this."

The first full-scale clinical trial is being planned in Hlabisa in Somkhele, about 220km north of Durban. It will be designed to test whether it is possible to ensure that people who are taking ART drugs comply with the strict prescription regime of daily pill taking, as well as discovering whether transmission rates fall below the level needed to sustain the epidemic.

"One quarter of the global cases are in southern Africa and one half of these are in South Africa, so South Africa is extraordinarily badly affected," Dr Williams said.

"We could stop transmission quickly, but it doesn't end the problem because people are infected with HIV for life. So we really are in it for the long term. We need to do a lot of operational research before we can consider this seriously as a public-health intervention, but there is a lot of enthusiasm for it," he added.

Originally published by By Steve Connor SCIENCE EDITOR, IN SAN DIEGO.

A service of YellowBrix, Inc.

Try Before You Buy Deal For Costly Rheumatoid Arthritis Drug

Mail on Sunday — Mon, 22 Feb 2010 10:51:00 +0100

By Oona Mashta

A costly new drug to treat severe rheumatoid arthritis is now available on the NHS after the manufacturer agreed to pay for the first 12 weeks of treatment - effectively allowing patients to try before they buy.

The first new drug for RA in more than a decade, Cimzia is one of a class of drugs called anti-TNFs, which are highly effective in easing the pain and swelling caused by the disease. But they are expensive, costing £10,000 to £15,000 a year, leading health chiefs to limit prescribing.

The National Institute for Health and Clinical Excellence (NICE), who provide guidelines for medics, originally said last October it would not recommend Cimzia. But it has now approved the drug after the Belgian-based pharmaceutical company UCB agreed to pay the initial treatment costs of £3,575, regardless of whether or not a patient responds to it.

The novel deal, which is set to revolutionise the treatment of RA, was agreed between the pharmaceutical company and the Department of Health through what is called a patient access scheme, whereby manufacturers can contribute towards a costly treatment. If patients continue on the treatment, it will cost the NHS about £14,300 a year.

There are around 350,000 RA sufferers in the UK. An estimated 40,000 of those suffer so severely it affects their ability to work and can cause permanent deformity of the joints. The progressively debilitating condition usually develops between the ages of 25 and 50 and it affects twice as many women as men.

RA occurs when the body's immune system attacks tissue around healthy joints, which swell and become painful. Despite extensive study, doctors do not know why it happens, although genetics are thought to play a role. It can occur in any joints, but particularly the fingers, hands and feet. In severe cases it can also cause organ damage, affecting the lining of the heart and lungs.

Anti-TNF therapy, a revolutionary family of drug treatments, was introduced in 2000 and has drastically changed the lives of rheumatoid arthritis sufferers worldwide. These medicines have proved effective in the ten per cent of patients who fail to respond to standard therapies, namely non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen, and disease-modifying antirheumatic drugs for more severe cases, which work by suppressing the immune system.

The most common of these is methotrexate, which is also used as chemotherapy.

Anti-TNFs have been shown to reduce the damage of the disease and in some cases put the patient into remission. Studies have found around three-quarters of patients who do not respond to diseasemodifying anti-rheumatic drugs respond well to anti-TNF therapy.

The drugs work by switching off a chemical enzyme called tumour necrosis factor, which plays an important role in causing inflammation and tissue damage in rheumatoid arthritis sufferers.

In an international clinical trial of Cimzia involving 1,601 patients, 80 per cent on the new drug responded to it, although there are four drugs currently available.

The new deal will effectively allow all patients to try two, one of them being Cimzia. Dr Richard Hull, consultant rheumatologist at Queen Alexandra Hospital, Portsmouth, said: 'This is the first such deal in the field of rheumatic drugs which can be very costly but can be life changing.

Because a patient doesn't respond to one TNF inhibitor, it doesn't mean they won't respond to another.'

www.arthritiscare.org.uk

Originally published by By Oona Mashta.

A service of YellowBrix, Inc.

My Little Miracle, By Mum Who Had 18 Miscarriages

Daily Mail — Fri, 19 Feb 2010 16:23:00 +0100

After suffering 18 miscarriages, Angie Baker hardly dared hope that her 19th pregnancy would be successful.

But thanks to pioneering treatment, she is a mother at last.

Yesterday, as she cuddled her tenweek-old daughter Raiya, she said: 'She's my little miracle. I can't explain how I feel. I'm overwhelmed. It seems like a dream and I still have to pinch myself. She's perfect in every way.'

Miss Baker, 33, from Peacehaven near Brighton, had her miscarriages over 13 years of hoping for a baby. She even discussed the possibility of adoption with her partner, Lee Gibson, a martial arts instructor.

But after the 17th disappointment, a friend read a newspaper article about Dr Hassan Shehata's work at Epsom and St Helier University Hospitals NHS Trust in Surrey.

Miss Baker was referred to him and a test found she was suffering from a common problem, thought to affect about 15 per cent of women. She had high lev-els of a subtype of white blood cell, known as Natural Killer (NK) cells, which are responsible for protection from viruses.

Because her NK cells were too aggressive, rather than protecting the pregnancy they mistook the foetus for a foreign body and attacked it.

Dr Shehata's treatment, using steroids, is pioneering because it starts before conception and the doses involved are higher than previously used.

However Miss Baker's troubles were not over. She became pregnant for an 18th time but it was then discovered she was diabetic, and the high sugar levels caused by the steroids resulted in another miscarriage.

Fortunately Dr Shehata was able to adjust her levels of insulin and the next pregnancy was successful. Raiya was born on December 9, weighing 7lb.

Dr Shehata said: 'The emotion that goes with every miscarriage is huge. Every time it's heartbreaking. A lot of people would give up so it's an amazing story in itself that she persevered.

'She's always smiling and that makes life easier. She's a dream patient.'

Dr Shehata, who sees patients from all over the world, said he had read about only one other case where a woman had had as many as 18 miscarriages before a successful birth. His team usually treats women who have suffered three or four miscarriages.

Dr Shehata said the team of six doctors at the trust has treated about 1,000 patients both on the NHS and privately since beginning the process in 2004 and said his technique resulted in an 80 per cent success rate for women suffering from high NK cell levels.

However he stressed that it would not help all women suffering recurrent miscarriage.

The Human Fertilisation and Embryology Authority, which regulates fertility treatment, advises that there is 'little scientific evidence to show these treatments are beneficial'.

IN young women, one in six pregnancies ends in miscarriage, rising to more than half in those over 45.

Most happen in the first three months and many women do not announce a pregnancy until past this milestone.

Half of miscarriages occur because of chance chromosomal abnormalities which trigger rejection by the body.

Other causes include infections and some specific illnesses such as rubella (German measles).

Fibroids in the womb can cause the problem, or a weak cervix, where the neck of the womb will not stay closed during pregnancy.

Immune problems may be a factor, when the mother's antibodies fight the pregnancy.

'Every time it's heartbreaking'

Originally published by Daily Mail Reporter.

A service of YellowBrix, Inc.

Blood Test Offers Hope to Cancer Sufferers

The Independent — Fri, 19 Feb 2010 10:33:00 +0100

By Steve Connor

DNA analysis will enable doctors to pinpoint whether treatment is working

Doctors may soon be able to tell whether cancer has been successfully eliminated from the body using a sensitive blood test that could dramatically change the way they are able to monitor the recovery of their patients.

The blood test, which detects the presence of the smallest amounts of defective DNA shed by cancerous cells, can show how well cancer patients are responding to successive courses of treatment.

Cancer treatment is difficult to monitor at present and usually involves cumbersome and expensive hospital scanners. A blood test that can check different stages of remission will be an invaluable tool in determining whether treatment has worked, scientists said.

Each test is tailor-made for an individual patient and works by identifying gross changes to the patient's DNA that occur during cancer. This "personalised" test distinguishes between a patient's healthy DNA and that which has changed as a result of a cancerous growth, giving scientists a way of seeing if a treatment is succeeding. The researchers predict that the test could soon be used routinely in the battle against the killer disease.

Although such "personalised medicine" based on sequencing a person's unique genome is still expensive - about 3,500 - the scientists believe the test will eventually become no more expensive, but much more effective, than current methods of monitoring cancer treatment.

"Eventually, we believe this type of approach could be used to detect recurrent cancers before they are found by conventional imaging methods, like CT scans," said Luis Diaz, assistant professor of oncology at Johns Hopkins Kimmel Cancer Centre in Baltimore.

Victor Velculescu, another Johns Hopkins scientist involved in the study, presented yesterday at the American Association for the Advancement of Science in San Diego, said: "There is currently no test for cancer patients that provides personalised biomarkers for clinical management of disease, and we feel that this is an important step in bringing new genome sequencing technologies to personalised patient care."

The technique, called personalised analysis of rearranged ends (Pare), differs from previous investigations of the genomes of cancer cells by looking at gross rearrangements of whole chunks of DNA rather than individual mutations in the "letters" of the genome.

Bert Vogelstein, of the Howard Hughes Medical Institute in Baltimore, said: "These alterations, like the reordering of chapters of a book, are easier to identify and detect in the blood than single-letter [genome] changes."

The scientists tested the Pare technique on six sets of cancerous and normal tissue samples taken from four patients with colorectal cancer and two with breast cancer. They found between four and 15 DNA rearrangements in each of the six samples.

The researchers were able to show how levels of the cancer- linked DNA in the blood fell after the initial surgery to remove the tumour, and subsequent bouts of radiation treatments, chemotherapy and secondary surgery.

Rebecca Leary, a member of the research team, said the aim was to develop a highly sensitive method of detecting any residual cancer that may be left after a course of treatment.

"As Pare becomes affordable, it will [help] physicians to tailor patient care and may become a useful supplement to traditional monitoring by imaging or other approaches," Dr Leary said.

Peter Johnson, Cancer Research UK's chief clinician, said: "The detection of DNA changes, unique to individual cancers, has proved a powerful tool in guiding the treatment of leukaemia. If this can be done for other types of cancer, like bowel, breast and prostate, it will help us bring new treatments to patients better and faster than ever."

Originally published by By Steve Connor SCIENCE EDITOR, IN SAN DIEGO.

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Rushed Carers Going Back To Finish Duties In Own Time

Edinburgh Evening News — Thu, 18 Feb 2010 17:28:00 +0100

By Gemma Fraser

Under-pressure carers have claimed they are being forced to go back to patients' homes in their own time because they no longer have enough time during the day.

Unions and care workers today said that the allocated time slots given to them were too short to carry out all the duties required in elderly people's homes - including administering medication.

They said carers often had to return to homes at the end of their shifts to finish tasks they should have had time to do earlier.

The Evening News revealed on Tuesday how home helps claimed they no longer had enough time to prepare a freshly-cooked hot meal for old people after the time they could spend with each person was cut from an hour to 30 minutes.

Now it has emerged that even the 15-minute medication slots are too short as carers are being given more responsibilities.

Marlyn Tweedie, Unison's health and social care spokeswoman, said that previously pharmacists would prepare all medication for patients in a dosette box and carers would simply have to administer the pills, which were already measured out.

However, she said pharmacists were increasingly unable to take on the extra workload and carers were being left to work out the dosage of medication and dispense it themselves, without being given any more time to do it.

Ms Tweedie said: "Carers are having to do more medical tasks which is more time-consuming, especially as it can include putting in eye drops or creams.

"Some of the elderly can be on 15 or 16 tablets which again takes a lot of time to give them all out.

"Carers' workloads have virtually doubled, with 14 or 15 people on a schedule whereas before they would have about eight.

"What Unison is saying repeatedly is that the amount of tasks are impossible to do in the amount of time given and this impacts on staff health and wellbeing and service delivery."

Ms Tweedie added that unexpected "emergencies" can often take place when a carer arrives at an elderly person's home, which takes them away from their normal duties.

She said: "You can get to somebody's house and they have fallen and you have to deal with that.

"More often than not if you phone up to ask for someone to cover your next job, the organiser doesn't have anybody so sometimes people are doing it in their own time."

The time which carers can spend in each home was scaled back in 2007 as part of a money-saving shake-up of home care provision.

One Edinburgh carer, who asked to remain anonymous, said there were frequently problems with the time slots for both preparing meals for elderly people and administering medication.

She said: "We do report it and sometimes we are allowed longer but not always.

"More often than not we either run late, putting stress on other carers, or even go back on our own time for which we can be sacked.

"It will get worse but its going to take some poor soul to get malnutrition through us not being able to check they've actually eaten before someone does something."

David Griffiths, chief executive of ECAS - a city-based group supporting disabled people - added: "It's very unfair for the carers, as well as the cared for, to be put in a position where they are not finishing a job to the standards they wish and but they have to leave."

A council spokesman said only 1.7 per cent of home care packages in the last year have involved visits of 15 minutes and that if staff were having problems they should report that to their manager.

He added: "The administering of medication is one part of a very important but usually wider care package that delivers a broad range of support, normally over several hours.

"The level of support needed varies from one person to the next with some requiring only a reminder to take medicines and others needing more help.

"We have very robust procedures in place and our staff get full training to ensure that this important task is carried out safely."

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Be Happy And Don't Have A Heart Attack

Daily Record — Thu, 18 Feb 2010 12:27:00 +0100

By Lachlan Mackinnon

If you want to avoid a heart attack, be happy and enjoy yourself.

That's the message from doctors who believe there's a strong link between happiness and a healthy heart.

Researchers found that happy people recover more quickly from stress and find it easier to relax.

And that means the nerves in their body which control blood pressure and heart rate work better.

People with a happy outlook also tend to sleep better and are less likely to smoke.

Walking Doctors in America found that grumpy people with gloomy attitudes were more than TWICE as likely to fall victim to cardiac disease, compared to the happiest patients.

And they believe people can take simple everyday steps to cheer themselves up and reduce their heart attack risk.

Heart expert Dr Karina Davidson, of New York's Columbia University Medical Cent re, said: "Ordinary people can ensure they have some pleasurable activities in their daily lives.

"If you enjoy reading novels but never get around to it, commit to get t ing 15 minutes or so of reading in. If walking or listening to music improves your mood, get those activities in your schedule.

"Spending a few minutes each day truly relaxed and enjoying yourself is certainly good for your mental health.

"And it may improve your physical health as wel l, a lt hough t h i s i s not confirmed yet."

Dr Davidson and her team followed 1739 male and female patients for 10 years, starting from 1995.

They found t hat t he happiest ones were more than twice as likely as the gloomiest to stay free of cardiac disease.

Dr Davidson said that if the findings are backed up by more research, they could revolutionise the methods doctors use to keep their patients safe.

"We desperately need rigorous clinical trials in this area," she added.

"If the trials support our findings, these results will be incredibly important in describing what clinicians and pat ients could do to improve health."

The findings are published in the European Heart Journal.

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While The Parties Squabble, The Elderly See Their Lives And Savings Ebb Away

The Independent — Thu, 18 Feb 2010 11:24:00 +0100

By Nigel Morris

Who will pay for our care in old age is a huge worry for many. So why do politicians ignore it, asks Nigel Morris

Time and money are fast running out for David Gower. Everyday life is a challenge for the 75-year-old pensioner who has lost most of the power in his limbs. He cannot hold a pen or stand unaided for more than a couple of minutes.

Carers visit him four times a day to help him in and out of bed and cook his meals. He relies on a walking frame to manoeuvre around his small flat and can only leave home in a wheelchair.

Mr Gower, who has suffered a severe and worsening neurological disorder for seven years, wants to keep as much of his independence as his condition allows. But the former British Rail manager's determination to stay in his own home is costing him dear. He calculates that his life savings are disappearing at the rate of £400 a month as he struggles to pay his care bills. At that rate all his money will be gone in less than two years.

Mr Gower, who lives in sheltered accommodation in Luton, said: "I have no idea what will happen then. It causes me, and a lot of other people like me, a great deal of concern. It's most unjust. I just want to stay in my own home."

Despite the seriousness of his condition, Mr Gower does not get all his care costs picked up because his needs are categorised as "substantial" rather than "critical". His monthly income, from pensions and benefits, is just over £600. But having to pay more than £300 towards his care on top of rent, food and bills, means he pays £400 from his savings each month.

He is one of many hundreds of thousands of frail and elderly people who receive care in their homes - and many more are in residential care. Many see their savings vanish - or are forced to sell their homes - to provide a modicum of dignity and comfort in their final years.

The system is close to breaking point and can only get worse as the expense of looking after a rapidly ageing population escalates. Forty per cent of the population will be 50 or over by the year 2026 - compared with 34 per cent now - meaning that another 1.7 million adults will require care.

In a report today the Audit Commission reinforces the message with a warning that councils face a daunting challenge in coping with soaring care costs, yet political leaders have so far baulked at facing up to the unpalatable decisions that will be required to tackle the problem.

Last week the Conservatives launched a poster campaign accusing Gordon Brown of plotting a 20,000 "death tax" on the estates of the newly deceased, and tomorrow the Tories will boycott an emergency conference called by Andy Burnham, the Health Secretary, to debate ways of tackling the funding crisis.

The issue looks certain to feature heavily in the general election expected in May - and will be given extra potency by the high turnout among older voters. The health spokesmen for the three main parties held secret talks either side of the New Year in an attempt to agree common ground on the issue. They collapsed in acrimony, with Labour and the Tories blaming each other for sabotaging the negotiations.

The fall-out continues. Mr Burnham has accused Andrew Lansley, the shadow Health Secretary, of spreading scare stories about Labour's intentions. Mr Lansley, who says the Government has wasted 13 years in which care could have been reformed, insists he will not go to the conference until Labour has ruled out imposing a levy on estates. Norman Lamb, the Liberal Democrat health spokesman, wrote yesterday to urge Mr Lansley to attend. He said: "We must set party loyalties aside and try to get to grips with this problem."

Michelle Mitchell, charity director of Age Concern and Help the Aged, reflected growing alarm among charities over the mug-slinging between the parties. She said: "The issue of social care is rightly in the spotlight; however it must not become a political football between the parties.

"Millions of older people and their families have been let down for far too long by an inadequate care system. The system is already underfunded and quality of care is often poor. Older people and their families deserve a care system which enshrines dignity and fairness - unless we act now it will crumble even further as our society ages."

As his savings ebb away, Mr Gower can barely contain his anger at the political point-scoring that has wrecked attempts to overhaul a system universally regarded as unfair. He is so disillusioned over the Government's failure to act that for the first time in 50 years, he will not vote Labour at the election. But the Tories and Liberal Democrats can take no comfort - he will support an independent candidate.

"All three main political parties have known for the last 20 years that this demographic problem is coming up. They have chosen to totally ignore all the warnings that care is in crisis. They don't want to accept responsibility - they have all adopted an out- of-sight, out-of-mind attitude."

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Do Doctors Ever Assist Suicide?

The Independent — Thu, 18 Feb 2010 10:34:00 +0100

By Jeremy Laurance

Do doctors kill? Ray Gosling claims that, in contravention of the Hippocratic Oath, some have helped patients end their lives and have even turned a blind eye while others - friends or family - carried out the deed, as he did for his dying lover.

He is almost certainly right about the former, but almost certainly wrong - except in the rarest of instances - about the latter.

No one knows how widespread the practice of euthanasia or assisted suicide is in the medical profession. Fifty years ago, country GPs assisting at a home birth would give a quick visual check of the newly delivered infant and, if all was not right, in some cases place a pillow over the baby's head and say: "I'm sorry Mrs Smith, there seems to be something wrong ..."

Such killings were widely, if privately, seen as merciful medicine. They would not happen today - doctors are less isolated, medicine is more tightly regulated and attitudes have changed. Instead, attention has switched to the other end of life and the question of how to "ease the passing" of the terminally ill by increasing the dose of painkilling drugs.

Central to this judgement is the doctor's intention. Privately, many will admit to having "crossed the line" between alleviating pain and shortening life. Occasionally, one breaks cover and sticks their head above the parapet. Earlier this month, the renowned cancer specialist Karol Sikora described how as a young registrar in the 1970s he had helped a 14-year-old boy with then-incurable leukaemia to die.

He wrote: "My consultant turned to me and said: 'Sikora, I don't want to see this boy again. Don't let him suffer.' I understood. I doubled his dose of morphine, which I knew could suppress his respiration. The child died overnight, peacefully, with his family around him. That is what doctors used to do. We didn't call it assisted suicide or euthanasia. We called it 'easing suffering'."

Easing suffering is what doctors are supposed to do. If this has the secondary effect of shortening life, that is an unfortunate but unavoidable consequence of the primary intention to relieve pain. But distinguishing which is the primary and which the secondary intention is in practice often difficult.

In the late-1990s, Dr David Moor, a Newcastle GP, claimed to have helped 300 patients die over a 30-year career. Unwisely, he let slip enough details of one case - that of 85-year-old George Liddell, a terminally ill cancer patient - for a prosecution to be brought.

It became clear during the trial that Dr Moor was being prosecuted for what he said rather than what he did. He was charged with giving Mr Liddell a lethal dose of morphine, but in court he claimed that all he had tried to do was relieve his patient's "agony, distress and suffering", as any other GP would have done. The jury acquitted him, but the judge punished him for his "silly remarks" by awarding a third of the costs against him.

Nigel Cox, a consultant rheumatologist at the Royal Hampshire County Hospital, could not rely on the same defence when he was accused of killing Lillian Boyes, 70, who had had arthritis for 13 years, was in extreme pain and had let it be known she wanted to die. Supported by Ms Boyes' family, Dr Cox gave her a lethal injection of potassium chloride. But the drug had no medical use other than to stop her heart. He was convicted of attempted murder and given a 12-month suspended sentence in 1992.

The ambivalence of the medical profession about assisted suicide was well caught by a 1996 Lancet editorial which said: "There is a gap between what the profession collectively states and what individual members in practice sometimes do, under a cover that smacks of sophistry."

Dr Michael Wilks, who chaired the British Medical Association's Ethics Committee for a decade until 2006, says: "I see this whole battle over the involvement of doctors in assisted suicide as the last battle for patient autonomy."

Originally published by Jeremy Laurance Health Editor.

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Happier staff..Happoer patients

Thu, 18 Feb 2010 08:53:06 +0100