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Medical- Transplants-The Last Screw -Keep the heart going until the Dr's gets out of bed
Updated: 21 Feb 2012
Keep dead people's hearts beating to up organ donation
16:05 16 February 2012 by Andy Coghlan
New Scientist
Is it morally right to restart a dead person's heart purely so it can be donated for transplant?
And would more babies in need of transplants be saved if the UK had a reliable test to guarantee potential donor babies are brain-dead?
Both tricky questions are posed this week by the British Medical Association in a report seeking new sources of organs to redress a shortfall in the UK.
Some 500 to 1000 British people die each year waiting for a transplant.
There is no test in the UK for diagnosing brain stem death in babies less than two months old.
Brain stem death is legally considered a sign of death in the UK, allowing doctors to identify potential donors before their organs begin to deteriorate.
Meanwhile, more adult donors could be found through the practice of restarting hearts in people who have just died of heart failure.
The approach was first demonstrated in the US in 2008.
Doctors at Papworth Hospital in Cambridge, UK, experimented – successfully – with the same technique on a donor in 2009.
The logic is that keeping the heart ticking helps preserve it for longer.
But the report cautions that the paradox of restarting the heart of someone who has just died of heart failure could confuse the public and damage confidence in donation.
It concludes that the best option to increase organ donation rates in the UK would be to make donation a default position from which people must "opt out" – at present the opposite is the case
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Medical - Pain Management- And a personal view
Updated: 18 Feb 2012
Pain management
From Wikipedia, the free encyclopedia
Pain management (also called pain medicine or algiatry) is a branch of medicine employing an interdisciplinary
approach for easing the suffering and improving the quality of life of those living with pain
The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists,
occupational therapists, and nurse practitioners.
Pain sometimes resolves promptly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as analgesics and (occasionally) anxiolytics.
Effective management of long term pain, however, frequently requires the coordinated efforts of the management team]
Medicine treats injury and pathology to support and speed healing; and treats distressing symptoms such as pain to relieve suffering during treatment and healing.
When a painful injury or pathology is resistant to treatment and persists, when pain persists after the injury or pathology has healed, and when medical science cannot identify the cause of pain, the task of medicine is to relieve suffering.
Treatment approaches to long term pain include pharmacologic measures, such as analgesics, tricyclic antidepressants and anticonvulsants, interventional procedures, physical therapy, physical exercise, application of ice and/or heat, and psychological measures, such as biofeedback and cognitive behavioral therapy
Radical
Sometimes surgical intervention is required.
When I was 11 years old in 1954 I had Otitis Media. - A middle ear infection. -
Without exaggeration, hitting my head against a wall was less painful than the pain in my head that I had to bear.
I never forgave or will ever trust the medical profession after that.
This went on for far too long !
If I have pain now I will not be fobbed off with "Take two Paracetamol".
I am not addicted to pain or pain killers either.
I am in favour of better pain management
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Medical - "Inadequate treatment of Pain is endemic within the Medical Profession"
Updated: 18 Feb 2012
Inadequate treatment of pain is widespread throughout surgical wards, intensive care units, accident and emergency departments, in general practice, in the management of all forms of chronic pain including cancer pain, and in end of life care.
This neglect is extended to all ages, from neonates to the frail elderly.
In September 2008, the World Health Organization (WHO) estimated that approximately 80 percent of the world population has either no or insufficient access to treatment for moderate to severe pain.
Every year tens of millions of people around the world, including around four million cancer patients and 0.8 million HIV/AIDS patients at the end of their lives suffer from such pain without treatment.
Yet the medications to treat pain are cheap, safe, effective, generally straightforward to administer, and international law obliges countries to make adequate pain medications available.[50]
Reasons for deficiencies in pain management include cultural, societal, religious, and political attitudes, including acceptance of torture.
Moreover, the biomedical model of disease, focused on pathophysiology rather than quality of life, reinforces
entrenched attitudes that marginalize pain management as a priority.
Other reasons may have to do with inadequate training, personal biases or fear of prescription drug abuse.
In the United States, Hispanic and African Americans are more likely to suffer needlessly in the hands of a physician than whites; and women's pain is more likely to be undertreated than men's.
It is often recognized that a great number of patients suffering from chronic pain are being under-treated because physicians fail to provide comprehensive pain treatment.
This failure may be due to physicians' fear of being accused of over-prescribing (see for instance the case of Dr William Hurwitz), despite the relative rarity of prosecutions (147 cases across USA in 2006), or physicians' poor understanding of the health risks attached to opioid prescription.
As a result of two recent cases in California though, where physicians who failed to provide adequate pain relief were successfully sued for elder abuse, the North American medical and health care communities appear to be undergoing a shift in perspective.
The California Medical Board publicly reprimanded the physician in the second case; the federal Center for Medicare and Medicaid Services has declared a willingness to charge with fraud health care providers who accept payment for providing adequate pain relief while failing to do so; and clinical practice guidelines and standards are evolving into clear, unambiguous statements on acceptable pain management, so health care providers, in California at least, can no longer avoid culpability by claiming that poor or no pain relief meets community standards.[56]
Strategies currently applied for improvement in pain management include framing it as an ethical issue; promoting pain management as a legal right, providing constitutional guarantees and statutory regulations that span negligence law, criminal law, and elder abuse; defining pain management as a fundamental human right, categorizing failure to provide pain management as professional misconduct, and issuing guidelines and standards of practice by professional bodies.[51 |
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Medical- Head Neck & Shouder Pain
Updated: 09 Feb 2012
Head Neck and Shoulder Pain
If such a cause is suspected or found then you will be referred to an appropriate physician.
This can be subcategorised very much like pain arising from the lower back with pain either being limited to the neck or present also in any combination of head, arms, shoulders and hands.
Another way of looking at the origin of neck pain is that it may arise from the neck or cervical vertebral bones, the spinal ligaments or the spinal musculature.
Some will also argue that superficial neck pain is a sign of pain arising from a cervical intervertebral disc.
This is discogenic pain.
There is a theory abounding that discogenic pain may be the main cause of what eventually becomes fibromyalgia or widespread body pain.
Pain limited to the neck
The cervical intervertebral joints are prone to degenerative or arthritic changes much the same as any other joint. The arthritic changes may also be inflammatory as in rheumatoid arthritis or ankylosing spondylitis.
This latter disease is an inherited condition where painful inflammation in the spine is eventually replaced by painless fusion of the vertebral bones. The cervical facet joints can be the source of neck pain although they are less recognised as being so in most pain clinics.
This is probably because it is much more difficult to inject into them compared to the thoracic and lumbar facet joints so fewer pain doctors undertake this type of work.
The risks are also greater with the underlying spinal cord and the vertebral arteries close by.
Instead they usually prescribe painkilling drugs and concentrate on treating the superficial trigger and tender points with steroid and even Botox injections.
TENS machines are also useful for some patients as are the topical NSAID and capsaicin creams.
Pain in the neck and arms
Whiplash injury with ligament and joint damage, slipped discs in the neck, degenerative arthritis in the neck and muscular neck injury with muscle spasm can all lead to symptoms in the neck, head, shoulders and arms.
As a result, differentiating between an individual’s symptoms to decide where there pain is coming from can be extremely difficult.
In addition, a patient may concentrate on neck and arm pain when actually they hurt all over and actually have fibromylagia or other such chronic pain syndrome.
Slipped neck discs are common and may lead to shooting or aching pains in specific parts of the head, arms and specific fingers.
Associated symptoms may include weakness in the upper limbs, pins and needles (parasthesiae or dysaesthesiae if painful) or even numbness.
Arthritic neck bones may also compress nerves and give the same symptoms.
If associated symptoms are severe, bowel and bladder function are affected or the MRI scan suggests an unstable spine with spondylolisthesis then referral to a spinal surgeon may be necessary if one has not already been seen.
Nerves from the neck form the Brachial plexus which goes on to give the nerve supply to the arms, hands and upper chest wall.
If this is damaged or invaded by cancer then it will also give neuropathic symptoms and signs.
Treatments
As with caudal and lumbar epidurals being effective for sciatica so cervical epidurals can be effective for slipped neck discs causing arm and hand pain.
The principle is the same as well with injection of steroid but this time even more care is required because the spinal cord lies beneath.
Cervical epidurals can be repeated 3-4 times a year if necessary but they should give good lengths of time of pain relief.
Others find TENS useful for their pains.
Muscle spasms in the shoulders are often responsive to Botox injections if they do not respond to simple acupuncture or trigger point injections with steroid.
Headache
Headaches can be looked at as being caused by problems in the head itself or resulting from problems in the neck and shoulders being referred to the head.
Migraine – most patients with migraine are treated successfully by their G.P.s and neurologists and rarely come to the pain clinic as a primary referral. Symptoms include changes in mood with one-sided headache, sensitivity to light, visual disturbance and sometimes nausea and vomiting.
These headaches can last for 4 to 72 hours.
Less commonly they are associated with an aura which describes associated visual disturbances or even episodes of speech impediment or weakness.
Treatment is with specific drugs e.g. migraleve (sumatriptan)
Cervicogenic Headache – secondary to pain from the neck.
Muscle spasm leads to irritation of the greater occipital nerves and pain on one or both sides of the head felt only as far forward as the forehead.
Greater occipital nerve block with steroid is often useful.
Tension Headache – lasts 30 minutes to 7 days at a time.
These are felt on both sides of the head and are distinguished from migraine as not being associated with nausea or vomiting or light or sound sensitivity.
Cluster Headache – This is severe one-sided pain affecting the area of the eye and above and behind it. The pain lasts for 15 minutes to 3 hours.
Attacks occur from one every other day to 8 a day and are associated with symptoms such as nasal congestion, excessive tears, runny nose, sweating, and swelling all on the same side as the headache.
Attacks occur in clusters lasting 4 to 10 weeks.
These are interspersed by pain free periods of months or years.
Treatment is mainly with drugs such as migraleve and abstinence from causal factors e.g. alcohol.
If the headaches occur 15 to 20 times a day and last for only 3-15 minutes then this is termed chronic paroxysmal hemicrania and the drug indomethacin, an NSAID, is usually successful.
Analgesic headache – Large doses of aspirin, paracetamol or codeine used to treat headache can actually aggravate headache themselves.
The same is true with sudden withdrawal form migraleve (sumatriptan).
Therefore these painkillers should not be taken everyday for headaches. |
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Medical -Would you prefer to see a Vet ?
Updated: 09 Feb 2012
“It shouldn’t happen to a Vet”
I once knew a farmer who when he was ill he never called the doctor but the Vet.
He reckoned that when the Doctor makes a diagnosis he asks a lot of questions and then he tells him what the matter is !
But with a Vet he can keep his mouth shut and he will tell him what is wrong with him.
Now that, said the farmer, is a clever fellow !
Animals don’t answer back – well not in so many words.
So what is a DIAGNOSIS ?
A Diagnosis is ….
Say: dy-ig-no-sus
……..” is a fancy name for how doctors figure out what's making you sick. Doctors collect all kinds of information to find out what's making you feel sick by asking questions and ordering tests, like blood tests or x-rays. After you are diagnosed with something, doctors can treat you with medicine and other things to help you get better!”
But there is a catch !
Making a diagnosis is only part of the story.
And giving it a fancy name is another part of the story.
Having a name for a condition is a relief for some Doctors who have no cure for the ailment.
They may treat the symptoms ( What the patient complains of) and he may observe signs that guide him to a diagnosis.
So how does the patient ask THE awkward question?
“Can you make me better ?”
That is the question he wants an answer to.
But the Doctor not wishing to disclose the “medical myth”
Replies – “We will get you better soon “ or " We will do our best "
Which may not be good enough..........
And gives the patient - (antibiotics) –no seriously -or something – sometime lots of medicines to convince the patient he is treating the disease.
Having "faith" has been pretty thin over the ages, but what is the alternative ?
Alternative medicine ?
Chinese medicine was frowned upon by Western medics - quite unsubstantiated
Telling the patient the truth is avoided until all else is explored.
Tests and more tests and more examinations !
Referrals are the best solution
Let someone else do the dirty work.
Which Is why whenever I go to see a Doctor and he asks me “how are you”
I say – I am dying slowly. – and I recommend you do likewise.
Unless it is a Vet your seeing !
Because of two sayings :-
“Doctors bury their mistakes”
And
“The operation was a great success unfortunately the patient died” |
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Medical- Save our National Health Service -Support the GP's who take industrial action
Updated: 20 Jan 2012
GPs willing to strike for pensions
Thursday 19 January 2012
by Tony Patey
Two in three doctors are prepared to take industrial action over government attacks on their pensions, the British Medical Association (BMA) revealed today.
Their threat of action - unprecedented over the last 40 years - dealt a massive blow to government hopes of an end to the bitter dispute.
It coincided with a warning by the head of the BMA that NHS changes are "causing chaos" in some areas.
Around 46,000 doctors took part in a BMA survey on pensions - a response rate of 36 per cent - with an overwhelming four in five saying the proposals should be rejected.
More than a third of doctors over the age of 50 said they intend to retire early if the changes go ahead.
BMA council chairman Dr Hamish Meldrum said: "The strength and scale of feeling among doctors is abundantly clear - they feel let down and betrayed, and for many this is the final straw.
"Doctors are at the forefront of attempts to save the NHS £20 billion, while trying to protect patient care, are in the midst of huge system reform in England, which is causing chaos in many areas, and are about to enter a fourth successive year of a pay freeze.
"Now, on top of this, they are facing wholesale changes to their pension scheme, which was radically overhauled less than four years ago and is actually delivering a positive cashflow to the Treasury."
He said forcing doctors to work to almost 70 is "one of our most serious concerns" as it might put pressure on doctors to work beyond an age at which they feel "competent and safe."
The BMA has written to the government rejecting its "final" offer and urging ministers to meet unions to agree to what the BMA says could be fairer changes.
An emergency BMA council meeting will be held on February 25 to decide on the options for balloting on industrial action unless there is a "significant" change in the government's position.
The BMA has not taken industrial action since the 1970s when there was a dispute over junior doctors' working conditions.
The Department of Health claims the current scheme is "unsustainable" and the reforms will ensure NHS pensions remain "among the very best."
tonyp@peoples-press.com
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Medical- RCN consults members on Pension offer
Updated: 19 Jan 2012
RCN to consult members on Government’s pensions offer
Published: 10 January 2012
All RCN members will have the opportunity to vote on whether to accept or reject the Government’s "final" proposals for the NHS pension scheme.
The announcement was made today following a meeting of RCN Council.
Professor Kath McCourt, Chair of RCN Council, said that Council members had recognised there will be no further improvement in the Government’s proposals but were aware of the depth of feeling on this issue.
“It is critical that nurses and health care assistants respond to our questions, have their say and influence what happens next,” she said.
Dr Peter Carter, RCN Chief Executive & General Secretary, said:
“We have repeatedly pointed out that nurses are simply asking for a fair deal for the frontline, as agreed in 2008.
NHS pensions have already been reformed and nurses have accepted the need to pay more for their income in retirement.
It remains a deep source of concern that nurses and health care assistants are still being asked to pay more, work longer and receive less.”
RCN members will receive full and detailed information in the coming days and weeks |
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Medical- BMA threaten strike action over Pension reform
Updated: 19 Jan 2012
BMA threatens industrial action after rejecting pension reforms
Trade union for 130,000 doctors and medical students says eight out of 10 respondents to survey rejected government proposals
guardian.co.uk,
The BMA said two-thirds of respondents to its survey would be prepared to take industrial action.
The British Medical Association, the trade union for 130,000 doctors and medical students, has threatened its first industrial action in more than 30 years after rejecting pension reforms.
Announcing the results of a UK-wide survey of members, the BMA said eight out of 10 respondents had rejected the pension proposals, which include higher contributions and working for longer.
Raising the spectre of its first unrest since 1975, the union added that two-thirds of those who took part in the poll would be prepared to take industrial action.
However, only 20% said they would be willing to strike, with the majority backing a campaign of action short of striking such as a work-to-rule protest. The BMA said 46,000 members responded to the survey.
It confirmed its rejection of the pension reforms in a letter to ministers, in which it urged the government to hold talks over changes to the proposals.
A statement added: "At the same time, the BMA will work up detailed plans on taking industrial action. All attempts will be made to ensure that any plans for action would minimise any risk of harm to patients."
An emergency meeting of the BMA council on 25 February will consider a ballot for industrial action if there is no significant change in the government's position.
Dr Hamish Meldrum, the chairman of the BMA Council, said the association was considering action "unprecedented in recent decades".
"The strength and scale of feeling among doctors is abundantly clear – they feel let down and betrayed, and for many this is the final straw," he said. "Doctors are at the forefront of attempts to save the NHS £20bn while trying to protect patient care […] in the midst of huge system reform in England, which is causing chaos in many areas, and are about to enter a fourth successive year of a pay freeze.
"Now, on top of this, they are facing wholesale changes to their pension scheme, which was radically overhauled less than four years ago and is actually delivering a positive cashflow to the Treasury."
The BMA's stance is a further blow to government hopes that deals can be reached on reforms to pensions for health, education, local government and civil service workers.
Unison, the largest public sector union, has agreed to continue further talks over government proposals on health and local government, but the Unite union has rejected the same outline deals while the largest civil service union, the Public and Commercial Services union, has rejected the civil servants' offer.
The NUT and NASUWT teachers' unions have also refused to sign up to the initial proposals.
However, a recent meeting of union leaders at the Trades Union Congress has not backed PCS calls for a repeat of the 30 November public sector walkouts.
The BMA, however, will still be free to join ongoing talks over reforms after the government rescinded a talks ban for any unions that had rejected the outline proposals.
Dean Royles, the director of the NHS Employers organisation, said: "Talks are the best way to secure a final deal. The NHS scheme talks are complex involving over a dozen unions so it's therefore welcome that, along with a number of other unions, the BMA will continue the discussions.
"It is essential that everyone now hammers out an agreement. Let's concentrate on securing the best sustainable deal, not on industrial action which will always be damaging to patient care."
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Medical- Keeping abreast of Consultants working in the NHS and Private Clinics
Updated: 09 Jan 2012
Breast implant scandal: Lansley and private clinics clash over free treatment
Private clinics rebuff health secretary after he appeals to their 'moral duty' over breast surgery cost
guardian.co.uk,
A PIP implant removed after surgery in a clinic in Nice. Lansley says private clinics are expected pay for PIP implants to be removed. Photograph: Eric Gaillard/Reuters
Andrew Lansley, the health secretary, is heading for a confrontation with the private cosmetic surgery clinics embroiled in the faulty breast implant scandal after they refused to comply with what he described as their "moral duty" to offer free surgery to worried women.
Investigations by the Department of Health have found no link to cancer, nor any reason for the routine removal of PIP implants, despite claims in France that they have a high rupture rate. But on Friday, Lansley said the low quality level of the silicone used in the French-made implants meant the NHS would offer free removal for women who were concerned and that private providers were expected to do the same.
Nuffield Health, BMI Hospitals and Spire have agreed to comply, but the government received a stern rebuke from Transform, the self-styled leading cosmetic surgery firm, which refused to agree with Lansley's demands and went on the attack against the government's handling of the scandal. Nigel Robertson, Transform's chief executive, demanded an urgent meeting with Sir Bruce Keogh, the NHS's medical director, in an escalation of the row which is threatening to become a major embarrassment to the government.
Robertson said: "The proposals announced by the Department of Health for the resolution of this situation have done nothing to reduce anxiety levels. We have asked for an urgent meeting with Sir Bruce Keogh to gain clarification of the statement and subsequent comments made in media briefings so that we are best able to plan our response."
Transform, whose turnover last year was £36.2m, is one of four major firms thought to have been involved in 60% of the 40,000 operations in which PIP implants were used. Linia Cosmetic also said it would only replace implants for free when "appropriate", adding: "We find that instead of clarifying the issues, government advice has not been clear and may increase confusion. We believe government is not fully accepting its responsibility and hiding what is essentially a massive regulatory failure."
The other two companies – the Hospital Group and the Harley Medical Group, – failed to return calls on Saturday about their policy on extractions. Callers to a helpline at the Hospital Group, which is owned by American businessman Paul Allen, were told that they would "not necessarily receive free treatment".
Sally Taber, director of the Independent Healthcare Advisory Services, the body representing the private health providers, refused to take questions on the conduct of her members and in a statement offered only free consultations for women who are worried.
Taber, who attacked the health department for its regulation of the industry, said: "All public and private sector surgeons used these [PIP] implants, which were not the cheapest on the market, in good faith with the knowledge that they had been approved by the Department of Health agency, the Medicines and Healthcare products Regulatory Agency. Our current advice to patients is to visit the website of their clinic provider and follow the advice detailed there. Patients can be assured that all of our member organisations are prioritising patient care above all else and all have undertaken to provide consultations without charge for women who would like to consult a surgeon."
Under the proposals announced by Lansley on Friday, the NHS will cover the costs for women who had the implants fitted by the health service and who are anxious to have them removed. It will also remove the implants if the private clinic no longer exists or refuses the patient. It is thought that 95% of women had the operation privately.
Andy Burnham, shadow health secretary, said he believed the government should do more to force all the private health companies to pay for extraction operations. He said: "While we accept the advice the government has given on the basis of evidence they have seen, we are disappointed that they are not providing more help to women affected.
"As a result, thousands of people are left in a difficult situation by this review. The government must appreciate how, for the vast majority of women affected, their statement on Friday was inconclusive. By implication, the suggestion was that the best course of action is to have implants removed. But they provided no practical help to the vast majority of people affected.
"It is an unacceptable state of affairs for any woman now to be left in a position where she is worrying about her health, and has no peace of mind, but is unable to afford to do anything about it. It is not enough for the government to say that the private providers have a 'moral duty' to their patients.
"Many women and their families will have been looking for a much stronger response from the government and will feel left in the lurch by this unsatisfactory statement."
A Department of Health spokesperson said: "Both the health secretary and Sir Bruce Keogh, NHS Medical Director, have been absolutely clear that the NHS will support the removal of PIP implants if the patient has concerns and with her doctor she decides that it is right to do so. We have been explicit that the NHS will help those who are either turned away by an unscrupulous clinic or whose clinic no longer exists."
* This article was amended on Sunday 8 January with a comment from the Department of Health
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Medical-Take Mayo on Myo-cardial Infarction-with Aspirin
Updated: 07 Jan 2012
Dr. Virend Somers, is a Cardiologist from the Mayo Clinic,
who is lead author of the report in the July 29, 2008 issue of
the Journal of the American College of Cardiology.
Most heart attacks occur in the day, generally
between 6 A.M. and noon. Having one during the night, when
the heart should be most at rest, means
that something unusual happened. Somers and his colleagues
have been working for a decade to show that sleep apnea is
1. If you take an aspirin or a baby aspirin once a day,
The reason: Aspirin has a 24-hour "half-life";
therefore, if most heart attacks happen in the
wee hours of the morning, the
Aspirin would be strongest in your system.
2. FYI,
Aspirin lasts a really long time in your medicine chest
for years, (when it gets old, it smells like vinegar).
Please read on.
Something that we can do to help ourselves - nice to know.
Bayer is making crystal aspirin to dissolve instantly on the tongue.
They work much faster than the tablets.
Why keep Aspirin by your bedside? It's about Heart Attacks -
There are other symptoms of a heart attack, besides the
pain on the left arm. One must also be aware of an intense
pain on the chin, as well as nausea and lots of sweating;
however, these symptoms may also occur less frequently.
Note: There may be NO pain in the chest during a heart attack.
The majority of people (about 60%) who had
a heart attack during their sleep did not wake up.
However, if it occurs, the chest pain may wake you up from
your deep sleep.
If that happens, immediately dissolve two aspirins in your mouth
and swallow them with a bit of water.
Afterwards:
- Call 911.
- Phone a neighbor or a family member who lives very close by.
- Say "heart attack!"
- Say that you have taken 2 Aspirins.
- Take a seat on a chair or sofa
near the front door, and wait for their arrival and
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Medical- Dr's bury their mistakes but most want to still play at being "God"
Updated: 06 Jan 2012
Terminally ill may win right to choose death
Radical says - If I am of no use to myself or society - what is the point of keeping me alive?
Join the "NTBR" brigade- "Not to be Resuscitated".- I do not give permission for you to thump on my chest.
Thursday 05 January 2012
by Louise Nousratpour, Equalities Reporter
Doctors in England and Wales may for the first time be allowed to help terminally ill people to die after a high-profile commission recommended relaxing the law around assisted suicide today.
A panel of legal and medical experts chaired by former lord chancellor Lord Falconer said adults with less than a year left to live should be able to ask their doctor for a lethal dose of medication.
But stringent safeguards must be in place to protect those who might not have the mental capacity to make such a decision or who might be under pressure from friends or relatives.
The commissioners also stressed that "good quality end-of-life care should be available in all settings."
Lord Falconer, who backs assisted suicide, stopped short of calling for legalisation but said current legislation was "inadequate, incoherent and should not continue."
The year-long probe, which has been mired in a row over impartiality, touched raw ethical nerves in campaigners on both sides of the argument.
Pro-euthanasia activists said its recommendations did not go far enough, calling for laws similar to those in Switzerland, where Dignitas clinics assist anyone who wishes to end their life.
But disability campaigners warned any changes to current legislation would put vulnerable people at risk.
Scope chief executive Richard Hawkes said he had "little confidence that the 'safeguards' would genuinely protect an individual who felt under pressure to end their life."
Royal Association for Disability and Rights chairman Phil Friend added: "In the midst of cuts, we are to believe that the social care budgets would be increased so everyone gets the palliative care they need?
"I'm sorry, I don't believe that."
The commission has also faced accusations of being biased given it was financed by author Terry Pratchett and businessman Bernard Lewis - both staunch supporters of Swiss-style clinics.
Peter Saunders of Care Not Killing claimed that nine of the 11 panel members were "known backers" of legalisation and that medical and legal experts opposed to the idea were not invited to join the panel.
"The overt bias in the structure of the commission is why over 40 organisations including the British Medical Association and many individuals boycotted the inquiry," he said.
louise@peoples-press.com
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Medical- Rationing GP Care- What State the National Health ?
Updated: 28 Dec 2011
Chronic shortage of family doctors leaves NHS in crisis
as some GPs are found to be responsible for 9,000 patients each
By Damien Gayle
Last updated at 1:36 PM on 27th December 2011
The NHS is facing a crisis as a chronic shortage of family doctors has left some overworked GPs responsible for a staggering 9,000 patients, according to official figures.
More than one million people were registered with a GP who served more than 3,000 patients, the figures show, which is nearly twice the 1,600 patients on an average list.
Now leading doctors have warned that the government's planned reforms of the healthcare system, led by Health Secretary Andrew Lansley, risk making the problem worse.
Overworked: Department of Health data shows that some family doctors must cover lists of a staggering 9,000 patients.
Dr Michael Dixon, chairman of the NHS Alliance, which represents the UK's primary care trusts, told the Daily Telegraph it was a question of whether GPs were 'able to cater as well for each patient with a list once they get much over 2,000 or 3,000.'
Shortages were already common in inner cities, he warned, but recruiting family doctors had become difficult even in affluent rural areas.
England has 25,000 family doctors, but the health service is facing a retirement crisis as one in eight GPs have signalled their intention to step down within two years.
A third of those said they were concerned about the effects of the government's planned health service reforms, the Telegraph reported.
Health Secretary Andrew Lansley's reform proposals risk making the problem worse, some doctors say
Pay freezes, pension changes and and increasing work loads were also given as significant factors behind many doctors' decisions to leave NHS work.
Shortages have been exarcerbated by the restrictions which allow the NHS from employing doctors from overseas only if there are no suitable staff in the UK or European Union.
With most British medical graduates going into hospital medicine, it is feared that the immigration block will further restrict the numbers willing to go to work in deprived inner city areas.
These spaces were filled in the Sixties and Seventies by a large influx of doctors from the Indian subcontinent, but this group are now reaching retirement and not being replaced.
There are also concerns at the increasing numbers of female GPs, who are set to outnumber their male colleages by 2013.
Women doctors are more likely to work part time because of family commitments, possibly leading to further shortfalls in coverage.
The Centre for Workforce Intelligence has recommended that an extra 450 GP training posts must be filled each year over the next four years to maintain staffing levels.
But the number of doctors training as GPs actually fell this year, even though there are more places on offer.
Dr Sarah Wollaston, a Tory MP and former family doctor, told the Telegraph that medical students see hospital careers as more glamorous.
Drama: Medical students are increasingly choosing to work as hospital doctors, a profession they perceive as more glamorous.
Doctors in the South East are having to treat the highest numbers of patients.
In primary care trusts such as Westminster, Brighton, Essex and Hounslow, west London, list sizes average over 2,000 per physician.
GPs working in Devon, Bristol and Somerset, in comparison, have only around 1,300 patients on average.
Two GPs - one in Camden, north London, and one in Newham, east London - have 9,000 patients each, according to Department of Health data cited by the Telegraph.
Overall, one in five GPs has a list of more than 2,000 patients.
A spokesman for the Department of Health told the Telegraph there was 'no evidence of difficulties accessing GPs'.
She added that the department planned to make training more flexible to attract more people to the job
Read more: http://www.dailymail.co.uk/health/article-2078949/GP-shortage-leaves-NHS-crisis-responsible-9-000-patients-each.html#ixzz1hlhjtf4b
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Medical- Post Traumatic Stress Syndrome - PTSD
Updated: 20 Dec 2011
Post-traumatic stress disorder (PTSD)
is a psychological and physical condition that is caused by very frightening or distressing events.
It occurs in up to 30% of people who experience traumatic events.
Traumatic events
PTSD can occur after experiencing or witnessing traumatic events such as:
military combat,
serious road accidents,
terrorist attacks,
natural or man-made disasters,
being held hostage,
violent deaths, and
violent personal assaults, such as sexual assault, mugging or robbery.
PTSD may also occur in any other situation where a person feels extreme fear, horror or helplessness. However, it does not usually develop after situations that are upsetting, such as divorces, job losses or failing exams.
Someone with PTSD often relives the traumatic event through nightmares and flashbacks.
They may also have problems concentrating and sleeping, and feel isolated and detached. These symptoms are often persistent and severe enough to have a significant impact on a person’s day-to-day life.
PTSD is a mental health condition
PTSD first came to prominence during the First World War after soldiers suffered harrowing experiences in the trenches. Their condition became known as shell shock or battle fatigue syndrome.
It has not been until fairly recently that it has been accepted that traumatic events outside of war situations have similar effects.
The term ‘post-traumatic stress disorder’ was first used after the Vietnam War. In 1980, PTSD officially became recognised as a mental health condition when it was included in the Diagnostic and Statistical Manual of Mental Disorders, which was developed by the American Psychiatric Association (APA).
How common is PTSD?
PTSD affects up to 30% of people who experience a traumatic event. It affects around 5% of men and 10% of women at some point during their life, and can occur at any age, including during childhood.
Approximately 40% of people with PTSD develop the condition after someone close to them suddenly dies.
Outlook
PTSD can be successfully treated even when it occurs many years after the traumatic event. Depending on the severity of your symptoms, and how soon they develop after the traumatic event, a number of different treatment strategies may be recommended. These include:
watchful waiting: waiting to see if the symptoms improve or get worse without treatment,
psychological treatment, such as trauma-focused cognitive behavioural therapy (CBT), or eye movement desensitisation and reprocessing (EDMR), and
medication, such as paroxetine or mirtazapine.
See Treatment for more information about the recommended treatments for PTSD.
If you have PTSD, it may affect your ability to drive safely. You must inform the Driver and Vehicle Licensing Agency (DVLA) if you have, or have previously had, a health condition that is likely to affect your ability to drive. See the DVLA website for more information.
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Medical - Surgeon resigns over NHS Cuts and Bad Management
Updated: 05 Dec 2011
Patients physically harmed by NHS
cuts and bad management, says surgeon
A devastating resignation email by a consultant orthopaedic surgeon has sparked inquiry
Rajeev Syal
guardian.co.uk, Thursday 1 December 2011 18.39 GMT
Radical says- This story would be so much more honourable if the Consultant had only worked for the NHS, but it appears he also has a lucrative Private Practice to support him.
Barts hospital in London, where David Goodier worked for most of his 31 years as a doctor before resigning in protest at standards of care. Photograph: Alamy
An inquiry has been launched into a leading London hospital trust after a consultant claimed in a devastating resignation email that poor management and government cuts had resulted in infections, pain and starvation for dozens of patients.
David Goodier, a consultant orthopaedic surgeon at Barts and the London NHS Trust, wrote that patients with broken bones were being physically harmed as managers strove to hit waiting list targets and squeeze budgets.
Prof Norman Williams, the president of the Royal College of Surgeons who works part time at the hospital, has also written to the hospital's medical council expressing his own concerns at an apparent "appalling deterioration" of surgical services. He warned that a failure to investigate could result in allegations of a cover-up similar to "Mid Staffs" – a reference to Mid Staffordshire hospital where hundreds of patients died because of substandard care.
As a result, the Royal College has been asked by the hospital to conduct an independent inquiry into Goodier's claims and similar complaints from other members of staff at the hospital.
The inquiry, uncovered by the Guardian, will result in calls for the Department of Health and the Care Quality Commission to intervene.
Goodier, 49, trained at the London hospital and has worked at the hospital trust for most of his 31 years as a junior doctor, registrar and consultant.
In his email, sent to colleagues in September, he claims that he went "ballistic" at the hospital authorities a year ago because of the lack of commitment to trauma services, where staff care for patients involved in car accidents, knife attacks and bad falls.
In response, he claimed, a manager "made clear that the only priorities of the trust were 18-week waiting times and the financial state".
Goodier considered resigning at the "disgusting" way trauma cases were being treated, he said, but over the next year conditions in the department deteriorated.
"Unfortunately, there has been a relentless increase in workload, combined with a relentless decrease in facilities," he wrote.
There is a shortage of equipment, including screws, bone substitutes and basic equipment which has made conditions "dangerous" for patients.
"We are regularly out of kit, out of nurses, out of ODPs [operating department practitioners who plan care] and always out of beds. We have become so used to the situation, it is no longer seen as a crisis, it is the norm."
Those who suffer are not emergency cases, he wrote, but those with less urgent needs who are left while their injuries fester.
"I did an operation last week on a calcaneal [heel bone] fracture that kept getting bumped by more urgent cases. It was three weeks down the line, and had healed in a bad position, there was nothing I could do about him.
"I fixed a compound tibia [leg bone] that was going to get a second look at 48 hours after the initial debridement; she got to theatre six days later," wrote Goodier.
He then described having to tell patients who are not allowed to eat or drink before an operation that their operations have been postponed.
"Most of all though, I have done ward rounds where I look patients in the eye and tell them they might sit around for three, four, five or even six days of sequential starving, no information, bed rest and sensory deprivation waiting for an operation that might get cancelled at the last minute because 'recovery is full', 'we used all the small fragment sets', '[a named outside contractor] have lost the trays', there's no II [image intensifier, a portable X ray machine] available' etc."
At the end of his email, Goodier told his colleagues that he could no longer stay because of the decline in resources.
"I have been complicit in a poor standard of trauma care and am guilty of negligence by association. I can no longer stand idly by when patients are at best having their human rights breached, and at worst physically harmed by the care they receive at BLT. It is personally a huge wrench to tear myself away from the hospital I started at as a medical student in 1980 and as a consultant in 1996 … Good luck to you all and goodbye," he wrote.
After receiving the email along with many other senior colleagues at the Trust, Williams replied: "I know you are one of the most dedicated surgeons in the Trust … I too have been troubled by the appalling deterioration of surgical services in this trust for some time. Whoever I talk to complains bitterly about the inability to deliver the high quality of care that they would wish to provide and which their patients have a right to expect … I believe that the Medical Council has a duty to alert the Care Quality Commission of the situation before further damage is done to our patients."
Williams then wrote an email to Prof Muhammad Magdi Yaqoob, the chairman of the medical council at the trust.
"There are clearly serious problems with the way that surgical treatment is being delivered in this trust especially for emergencies and that does not just mean trauma. The consultant body has a duty to act otherwise they will be deemed to be complicit. I only have to mention Mid Staffs here to alert you to the problem," he wrote.
Insiders at the hospital claim that a number of consultants have voiced their concerns, particularly about non-urgent surgery. Some blamed the lack of resources on the hospital's PFI scheme which they say has drained resources. Others say that managers have no idea how surgeons and consultants actually work.
Williams praised the hospital trust on Thursday and said that he had heard many criticisms from senior staff but also some support for the way it runs many of its departments.
Dale Campbell-Savours, the campaigning Labour peer who has asked parliamentary questions about the resignations of six senior consultants at the trust, welcomed the inquiry. "The loss of consultants at this hospital with an international reputation has been of great concern," he said.
A spokeswoman for the trust confirmed the Royal College inquiry and has invited a medical director from a foundation trust to undertake a review. She said it was decided that it was not "appropriate' to contact the CQC.
She added said that the concerns about availability of surgical instruments had been addressed and significant improvements had been made. "Barts and the London NHS Trust has one of the best clinical safety records in the NHS, and we have the second lowest SHMI [summary hospital-level mortality indicator] mortality rate in England … We have taken this as an opportunity to expand our orthopaedic service," she said. |
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Medical-The appalling State of the NHS in one Consultants resignation letter
Updated: 03 Dec 2011
Patients physically harmed by NHS cuts
and bad management, says surgeon
A devastating resignation email by a consultant orthopaedic surgeon has sparked inquiry
Rajeev Syal
guardian.co.uk, Thursday 1 December 2011 18.39 GMT
Barts hospital in London, where David Goodier worked for most of his 31 years as a doctor before resigning in protest at standards of care.
An inquiry has been launched into a leading London hospital trust after a consultant claimed in a devastating resignation email that poor management and government cuts had resulted in infections, pain and starvation for dozens of patients.
David Goodier, a consultant orthopaedic surgeon at Barts and the London NHS Trust, wrote that patients with broken bones were being physically harmed as managers strove to hit waiting list targets and squeeze budgets.
Prof Norman Williams, the president of the Royal College of Surgeons who works part time at the hospital, has also written to the hospital's medical council expressing his own concerns at an apparent "appalling deterioration" of surgical services.
He warned that a failure to investigate could result in allegations of a cover-up similar to "Mid Staffs" – a reference to Mid Staffordshire hospital where hundreds of patients died because of substandard care.
As a result, the Royal College has been asked by the hospital to conduct an independent inquiry into Goodier's claims and similar complaints from other members of staff at the hospital.
The inquiry, uncovered by the Guardian, will result in calls for the Department of Health and the Care Quality Commission to intervene.
Goodier, 49, trained at the London hospital and has worked at the hospital trust for most of his 31 years as a junior doctor, registrar and consultant.
In his email, sent to colleagues in September, he claims that he went "ballistic" at the hospital authorities a year ago because of the lack of commitment to trauma services, where staff care for patients involved in car accidents, knife attacks and bad falls.
In response, he claimed, a manager "made clear that the only priorities of the trust were 18-week waiting times and the financial state".
Goodier considered resigning at the "disgusting" way trauma cases were being treated, he said, but over the next year conditions in the department deteriorated.
"Unfortunately, there has been a relentless increase in workload, combined with a relentless decrease in facilities," he wrote.
There is a shortage of equipment, including screws, bone substitutes and basic equipment which has made conditions "dangerous" for patients.
"We are regularly out of kit, out of nurses, out of ODPs [operating department practitioners who plan care] and always out of beds.
We have become so used to the situation, it is no longer seen as a crisis, it is the norm."
Those who suffer are not emergency cases, he wrote, but those with less urgent needs who are left while their injuries fester.
"I did an operation last week on a calcaneal [heel bone] fracture that kept getting bumped by more urgent cases. It was three weeks down the line, and had healed in a bad position, there was nothing I could do about him.
"I fixed a compound tibia [leg bone] that was going to get a second look at 48 hours after the initial debridement; she got to theatre six days later," wrote Goodier.
He then described having to tell patients who are not allowed to eat or drink before an operation that their operations have been postponed.
"Most of all though, I have done ward rounds where I look patients in the eye and tell them they might sit around for three, four, five or even six days of sequential starving, no information, bed rest and sensory deprivation waiting for an operation that might get cancelled at the last minute because 'recovery is full', 'we used all the small fragment sets', '[a named outside contractor] have lost the trays', there's no II [image intensifier, a portable X ray machine] available' etc."
At the end of his email, Goodier told his colleagues that he could no longer stay because of the decline in resources.
"I have been complicit in a poor standard of trauma care and am guilty of negligence by association. I can no longer stand idly by when patients are at best having their human rights breached, and at worst physically harmed by the care they receive at BLT.
It is personally a huge wrench to tear myself away from the hospital I started at as a medical student in 1980 and as a consultant in 1996 … Good luck to you all and goodbye," he wrote.
After receiving the email along with many other senior colleagues at the Trust, Williams replied: "I know you are one of the most dedicated surgeons in the Trust … I too have been troubled by the appalling deterioration of surgical services in this trust for some time.
Whoever I talk to complains bitterly about the inability to deliver the high quality of care that they would wish to provide and which their patients have a right to expect … I believe that the Medical Council has a duty to alert the Care Quality Commission of the situation before further damage is done to our patients."
Williams then wrote an email to Prof Muhammad Magdi Yaqoob, the chairman of the medical council at the trust.
"There are clearly serious problems with the way that surgical treatment is being delivered in this trust especially for emergencies and that does not just mean trauma.
The consultant body has a duty to act otherwise they will be deemed to be complicit.
I only have to mention Mid Staffs here to alert you to the problem," he wrote.
Insiders at the hospital claim that a number of consultants have voiced their concerns, particularly about non-urgent surgery.
Some blamed the lack of resources on the hospital's PFI scheme which they say has drained resources.
Others say that managers have no idea how surgeons and consultants actually work.
Williams praised the hospital trust on Thursday and said that he had heard many criticisms from senior staff but also some support for the way it runs many of its departments.
Dale Campbell-Savours, the campaigning Labour peer who has asked parliamentary questions about the resignations of six senior consultants at the trust, welcomed the inquiry.
"The loss of consultants at this hospital with an international reputation has been of great concern," he said.
A spokeswoman for the trust confirmed the Royal College inquiry and has invited a medical director from a foundation trust to undertake a review.
She said it was decided that it was not "appropriate' to contact the CQC.
She added said that the concerns about availability of surgical instruments had been addressed and significant improvements had been made.
"Barts and the London NHS Trust has one of the best clinical safety records in the NHS, and we have the second lowest SHMI [summary hospital-level mortality indicator] mortality rate in England …
We have taken this as an opportunity to expand our orthopaedic service," she said. |
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Medical- Israeli Doctors are complicit in systematic torture
Updated: 16 Nov 2011
New Report Reveals:
In Israel's Health Care System Covering Up Torture and Ill Treatment is the Norm
03.11.2011
New Report Reveals:
In Israel's Health Care System Covering Up Torture and Ill Treatment is the Norm
A new report by the Public Committee Against Torture in Israel (PCATI) and Physicians for Human Rights – Israel (PHR) based on over 100 complaints reveals that medical professionals are involved in torture and in covering it up, in violation of ethical obligations.
The report details different forms of medical community involvement such as failing to medically document torture, failing to report suspicions of detainee abuse, transmitting medical information to interrogators and returning victims to their interrogators.
According to the report the Israeli health system fully backs medical involvement in torture and fails to provide health workers with the means to uphold their ethical obligations to torture victims.
Human rights organizations, The Public Committee Against Torture in Israel (PCATI) and Physicians for Human Rights – Israel (PHR) released a pioneering new report that reveals the involvement of physicians in ISA (Shin Bet) torture of interrogees.
The report is based on over 100 files that PCATI handled since 2007 in which medical personnel involvement in torture, either directly or indirectly, is demonstrated and this in violation their ethical and moral obligations as medical doctors.
The report reveals different forms of involvement or cover up of torture by physicians in the civilian medical system or by those in the security services such as:
Lack of proper medical reporting regarding injuries
Failing to report possible torture to the authorities that victims report or as is evident in their physical or psychological condition
Returning detainees to their interrogators even when it is clear that they were injured during interrogation
Transmission of medical information to interrogators without the consent of the patient and in violation of the rights of patients
Demonstrated preference for the needs of the interrogator over the good of the patient
The Israeli medical system, both the civilian and those attached to the security establishment, has consistently failed to provide their member physicians with the means to properly uphold their obligations to their patients and to protect torture victims.
There is no channel for reporting suspicions of torture; there is no proper punishment and no protection for those who wish to report torture.
Similarly Israeli medical ethics does not clearly place the integrity of the patient above security needs.
The report reveals a disturbing picture in which physicians, who come into contact with detainees form another layer of protection for government interrogators, who use torture and ill treatment.
Physicians consistently fail their detainee patients, many of whom are interrogated in isolation and held incommunicado, and for whom the physician is his only contact with outside world.
With Israel's systematic impunity as a backdrop, in which over 700 reports of torture to the Attorney General over the past decade have not been investigated, Physician failure to protect is especially disturbing.
Dr. Ishai Menuchin, Executive Director of PCATI said today: "We expect physicians to support helpless people.
Much to our surprise the contrary is true where before helpless individuals, cut off from the world but for their interrogators, we find physicians, lacking the most basic human decency, completely backing up the torturers."
The PHR Ethics Committee in connection to transferring medical information to interrogators: "Reality forces physicians working in detention facilities to balance and give more weight to the interests of their employers and the general public over that of their patient and his individual interests.
In the absence of clear rules and systematic clinical directives derived from professional ethics physicians will continue to be placed in impossible situations that compromise their ethical integrity.
"The Ethics Committee stated further that the rules will be effective only if they will come directly from the Ministry of Health which is obligated to support and assistance to physicians chronically facing such dilemmas |
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Medical - GP Prescriptions cost £millions of tax payers money to profit drug companies
Updated: 13 Nov 2011
GP Prescriptions cost millions
Doctors are prescribing patients with readily available medicines,costing the health service millions, according to NHS data.
GP’s spent more than £3000 on cold and flu remedies and more than £59,000 on prescriptions for over the counter painkillers from January to June.
The NHS spent £442 m on painkillers prescribed by doctors,including those not available over the counter in 2010/11
This compares to a total of £410m in 2009/10 and £384m in 2008/09
The Radical points out
......that Drug companies profit from GP’s prescriptions and that GP’s can only prescribe what is available on the NHS list and the market.
......that GP’s are prescribing for groups including pensioners and children who don’t pay for their GP prescriptions
......that the drug brands used by the NHS drug authority are often the most expensive on the market when many generic drugs, manufactured by the NHS, would reduce the bill considerably. (and drug company profits)
......that it is high time that the Health Secretary stopped this expensive waste of public money, buying drugs from the Drug Companies that cost most, when with better and more prudent purchasing the nations drug bill could be dramatically reduced without affecting quality, as quality controls should already be in place. |
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Medical-Unqualified GP Receptionists issue drug prescriptions without Medical authority or checks
Updated: 13 Nov 2011
4 November 2011 Last updated at 00:58
GP receptionists play a "hidden" role
in ensuring patients get the correct treatments
when they need them,
says a study in the British Medical Journal.
Researchers from Queen Mary, University of London, analysed how four UK surgeries organised repeat prescriptions.
They found that receptionists used their knowledge and experience to make a computer-based process run safely.
Training should not just focus on technology, says the study.
Repeat prescriptions are defined as prescriptions issued without a consultation between the GP and patient.
They account for up to three-quarters of all drugs prescribed and four-fifths of drug costs in UK general practice.
Around half of all registered patients receive treatment by repeat prescription and rates are rising, the authors of the study say.
With electronic records and computer systems in most GP practices, patients assume that issuing these prescriptions is a simple, automated process.
But this study, in which researchers spent 395 hours directly observing the work of receptionists and other administrative staff, found repeat prescribing to be a complex, technology-supported social practice, requiring collaboration between clinicians and administrative staff.
"Receptionists in some practices expressed concern that doctors did not check prescriptions thoroughly before signing”
Deborah Swinglehurst, lead study author and research fellow at the Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry at Queen Mary, University of London, said there was a gap between formal procedures and what actually happened on the ground in doctors' surgeries.
"This includes important 'hidden' creative work by front line reception staff."
'Tacit knowledge'
The study found that over half of the requests for repeat prescriptions were for items that either were not listed as repeats on the patient's electronic record or were listed by a different name, at a different dose, or as due earlier or later than the date they were requested.
As a result, issuing repeat prescriptions without first passing them to a GP for their attention "required explicit and tacit knowledge", the study said.
"For example, many were adept at using a formulary to match brand names with generic equivalents; they often telephoned patients to clarify ambiguous requests, and many kept (individual or shared) notebooks containing knowledge they had gleaned on the job."
Some receptionists, the study found, were aware of having to make up for the failings of their doctors.
"Receptionists in some practices expressed concern that doctors did not check prescriptions thoroughly before signing.
They believed that because of this they had a heavy responsibility to undertake safety checks themselves, although these were not recognised or remunerated."
Despite not being accountable for certain aspects of quality and safety, reception staff still considered themselves informally accountable to the patient, the study added.
The study authors conclude that there is no best way of running repeat prescribing.
But they highlight the importance of ensuring that training for repeat prescribing goes beyond simply training receptionists on how to use their practice's computer system.
Writing about the research in an editorial in the BMJ, Professor Anthony Avery, professor of primary health care, University of Nottingham Medical School, said it was important to establish whether prescribing error rates vary much between general practices.
"If they do, the complex factors identified by Swinglehurst and colleagues need to be taken into account when designing and testing interventions aimed at improving safety.
"This might then produce better evidence to help guide general practices on the best ways of running their repeat prescribing systems to ensure safety while being responsive to patients' requests."
A spokeswoman from the British Medical Association said: "GPs recognise that receptionists have a very important part to play in the whole process."
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Medical- Aspirin the world's most underrated drug, can cut risk of cancers
Updated: 30 Oct 2011
Aspirin may be the breakthrough in war on lung cancer
by BEEZY MARSH, Daily Mail
The Radical takes Aspirin 75mg E.C. daily. EC ? Enteric Coated,so they pass the stomach before being released.
He has been taking it to prevent a stroke. And you ? If not ask your GP !
Aspirin could be a powerful weapon against Britain's biggest cancer killer, experts said yesterday.
A U.S. study found that the painkiller can help cut the chance of developing the most common form of lung cancer by more than 50 per cent.
The risk of getting any form of the disease, which claims around 37,000 lives in Britain every year, was reduced by up to a third by regularly taking aspirin.
The news is the latest in a string of discoveries about the health benefits of aspirin, which was invented more than 100 years ago.
It is already taken daily by more than two million angina sufferers and heart attack survivors in the UK to protect against further attacks and against strokes.
Thousands more take it to ward off heart disease.
Many arthritis sufferers also benefit from aspirin's painkilling properties and there are indications that it can give some protection against stomach cancer, even though it can also cause irritation of the stomach lining.
The latest study, published in the British Journal of Cancer, is the first evidence that aspirin can keep lung cancer at bay, even among smokers.
Experts from New York University School of Medicine questioned more than 14,000 women about long-term aspirin use.
They then compared those who went on to develop lung cancer with those who stayed in good health, and attempted to relate aspirin use to the chances of developing the disease.
They found that taking aspirin three or more times a week for at least six months was enough to reduce the risk of developing any form of lung cancer by a third.
The reduction was even greater for a form called nonsmall cell lung cancer, which accounts for about threequarters of all deaths. Regular aspirin users were less than half as likely to develop this form.
The researchers found that a history of smoking, which causes 90 per cent of lung cancers, was by far the biggest risk factor.
But even among women in that group, regular doses of aspirin could cut the danger.
Although the study looked only at women, experts from Cancer Research UK, which publishes the British Journal of Cancer, said there was no reason to expect the results would not be repeated in men.
However, the charity warned that the study did not look into the dosage of aspirin.
There are also concerns that, because the drug is very cheap and widely available over the counter, people may start self-medicating in the hope of avoiding lung cancer.
Survival rates for lung cancer in the UK are poor, with only around five per cent of sufferers still alive five years after diagnosis.
But a spokesman for Cancer Research UK said no one should start taking regular aspirin without consulting their GP because some people can suffer irritation of the stomach lining.
This can lead to bleeding and ulcers, although some aspirin preparations now have a special chemical to help protect the delicate gastric lining.
Scientists do not know exactly why aspirin seems to protect against some cancers but its anti-inflammatory properties are being investigated.
The Cancer Research UK spokesman said: 'There is increasing evidence that molecules involved in the body's inflammatory response may also contribute to the development of the disease.'
Professor Gordon McVie, director general of Cancer Research UK, said: 'Aspirin is a remarkable drug with a wide range of health benefits, and this is the latest evidence to suggest it could become a useful weapon against cancer.
'But as much as these results are encouraging, people shouldn't fool themselves into thinking that taking aspirin somehow counteracts the dangers of smoking.
' Everything else pales into insignificance compared with the lethal effects of tobacco.'
A second study in the British Journal of Cancer predicts that the UK's lung cancer death toll will fall over the next five years as more people stop smoking.
Researchers who used World Health Organisation mortality figures for 20 European countries said deaths among men under 75 would decrease by one in five.
Among under-55s, they predicted decreases of 26 per cent in men and 15 per cent in women.
Facts about aspirin
1. Aspirin is the common name for acetylsalicylic acid - a painkiller which can be traced back to Greek times.
2. Hippocrates, the father of modern medicine, used it in the fifth century BC to relieve the pain of childbirth and the aches produced by fevers. He used potions made from the leaves and bark of willow, which contain the chemical salicin.
3. The Romans also used willow, as did English clergymen in the 1750s.
4. In the 19th century, scientists developed medicines based on salicin - salicylic acid and sodium salicylate. But they were not popular, as they tended to irritate the stomach.
5. In 1897, German chemist Felix Hoffman tried to concoct a less acidic formula to ease his father's arthritis.
6. The result, aspirin, was first marketed in Germany - it was the first drug sold in water-soluble tablets - and rapidly became popular everywhere.
7. An estimated one trillion tablets have now been swallowed around the globe. Britons are thought to consume around five tons of aspirin every day, and the drug can be found in most homes.
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Medical- 100,000 written Hospital complaints in a single year-
Updated: 08 Oct 2011
Hospital Complaints
The number of written complaints exceeds 100,000 in a single year.
Appalling stories of neglect and misdiagnosis.
44% against Medical Staff-22%against Nurses and the balance against Hospital Trusts.
By far the greatest complaints are against Hospital Acute – Impatient and Outpatient services
If you are thinking of making one – try ICAS first.
Independent Complaints Advocacy Service and or:-
The Patients Association who are running a survey on Patient denials. |
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Medical- Wireless Network Could help Snoring and Sleep Apnoea
Updated: 05 Oct 2011
Wireless network can watch your breathing
16:08 27 September 2011 by Melissae Fellet
New Scientist
It's not easy sleeping with tubes up your nose, but when doctors want to monitor a person's breathing they have few other choices.
A new wireless system promises to do away with intrusive medical technology – but instead it might end up being used as a surveillance tool to track people's movements and activities behind closed doors.
While testing some new equipment, Neal Patwari of the University of Utah in Salt Lake City and colleagues noticed variations in wireless signal strength triggered by a person's breathing, but only at certain locations around the room.
So they set up an experiment to test whether a wireless network could reliably measure breathing rate.
In the test, Patwari lay in a hospital bed surrounded by 20 inexpensive, off-the-shelf wireless units.
These were arrayed so that they sent 2.4 gigahertz radio waves across the bed – the same frequency as Wi-Fi – but with one-thousandth the power of a laptop's wireless card.
The units measured the signal strength four times a second – fast enough to measure fluctuations caused by individual breaths.
After collecting 30 seconds of data, the network was able to accurately estimate a person's breathing rate to within 0.4 breaths per minute.
Patwari concludes that the wireless signals bent around his chest as it rose with each inhalation, causing them to travel a longer distance and decrease slightly in power.
Unmasking
The technology could allow people to rest more comfortably during sleep studies, Patwari says, without being connected to machines by wires and tubes.
He contends that the system could be used to augment current medical tests for lung capacity, too.
But current medical breathing monitoring methods are more than adequate, says Salvatore Morgera at the University of South Florida in Tampa.
These methods also measure the amount of carbon dioxide in exhaled gases, collected in a mask or a tiny tube in each nostril, whereas wireless monitoring would just increase the clutter of radio waves in a modern hospital.
If it doesn't find a use in medicine, the device may still interest snoopers.
In a previous study, Patwari and a colleague showed that because radio signals at Wi-Fi frequencies can penetrate walls, a wireless network set up outside a home could track people as they move from room to room.
With this new level of precision, a system tailored for surveillance could spy on people as they move around a hotel room, for example, or even discern whether they are resting on a couch or in bed.
Journal reference: arxiv.org/1109.3898
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COMPENSATION CLAIMS FOR A LACK OF TRUST IN HOSPITAL TRUSTS-MEDICAL
Updated: 26 Sep 2011
Medical Negligence Claims |
Medical Claims for Compensation
Panel of Medical Negligence Solicitors | No Win No Fee | 100% Medical Injury Compensation | Private Remedial Treatment and Care (at no cost to you) | Free Medical Negligence Claim Assessment
5r1 Claims has an expert panel of medical negligence claims solicitors who have assisted victims of medical negligence across England and Wales pursue a medical negligence claim for compensation.
The 5r1 Claims medical negligence claims service is provided on a 'no win no fee', at no cost to the claimant who is making the medical negligence claim.
5r1 Claims believes that its is crucial that victims of medical negligence, have access to an independent medical negligence claims solicitor and independent medical experts that can provide independant advice on a 'no win no fee' basis (as medical negligence claimants can be turned down legal aid, due to their circumstances).
For this reason 5r1 Claims has a medical negligence claims department that works closely with a panel of expert medical negligence claims solicitors.
10 facts about our medical negligence claims service
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We have a specialist department handling both the straight forward to the more complex medical negligence claims (also known as clinical negligence claims).
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We have access to an specialist panel independent medical negligence claims solicitors.
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We can assist with minor injury medical negligence claims through to the serious and fatal injury medical negligence claims.
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We will assist by taking the information about the medical negligence claim over the telephone, rather than making you fill out tedious amounts of paperwork (home visits can be arranged, if preferred).
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If you decide to claim through our panel of medical negligence claims solicitors, should your medical negligence claim be successful then you will receive 100% medical injury compensation, we make no deductions from your medical negligence claim.
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Should your medical negligence claim be unsuccessful, then we will not charge you. ('no win no fee')
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Our panel of medical negligence claims solicitors aim to settle your medical negligence claim efficiently and with maximum injury compensation.
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Our medical negligence claims solicitors will not just advise you on making a medical negligence claim, but will support you throughout.
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Where medical negligence has not been confirmed, we can arrange an opinion from an independent medical expert before you decide to make a claim.
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Unlike other firms who would normally charge you a fee for this service, we will not charge you.
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If the client requires physiotherapy or private medical treatment or remedial treatment after an accident or medical negligence this can be arranged at no cost to you. (free private treatment)
Panel of Medical Negligence Claim Solicitors
Our panel of medical negligence claims solicitors or 'medical negligence claims lawyers' (as some clients refer to them as) consist of not one but several national law firms who specialise in different types of medical negligence claims.
Some of the types of medical negligence claims which our solictors are experienced in handling are listed below.
- Hospital Negligence Claims
- Claims agains a GP
- Claims against the NHS
- Late or Inaccurate Diagnosis
- Birth Injury Claims
- Cerebal Palsy Claims
- DVT and Bedsore Claims
- Failure to take X-rays / Scans
- Prescription Errors & Mistakes
- Accident & Emergency Failures
- Anaesthetic Mistakes & Errors
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- Surgical Error Claims
- Misdiagnosed Cancer Claims
- Misdiagnosed Fractures
- Wrongful Death Claims
- Claims against Paramedics
- Cosmetic Surgery Claims
- Private Hospital Claims
- Claims against a Aethetist
- Maxillofacial Errors & Mistakes
- Nerve and Organ Damage
- Other Medical Negligence Claims
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Medical Negligence Compensation
Our experts panel of medical negligence claims solicitors have experience in recovering:
- 100% compensation for the medical Injury
- Loss of earnings
- Private medical treatment
- Rehabilitation costs
- Private care costs
- And any other out of pocket expenses
Unlike some of our competitors we make no deductions from your medical negligence claim for compensation as the legal costs will be recovered directly from third party or the insurer of the third party along with the claimants compensation and expenses (as mentioned above).
Our panel of medical negligence claims solicitors can provide free legal advice on making a medical negligence claim for compensation & will even carry out a free medical negligence claim assessment of your medical negligence claim. You are under no obligation to instruct the medical negligence claims solicitor after the initial free medical negligence claims assessment.
Medical negligence claims can be made for negligence which has occurred recently or in the past, but it is important that you look into making a medical negligence claim within the set time limits.
Free Impartial Medical Negligence Claim Advice
If you or a loved one has suffered from medical negligence, then contact 5r1 Claims.
Our expert panel of medical negligence claims solicitors can provide you free legal advice on making a medical negligence claim.
5r1 claims will not ask you to pay if your medical negligence claim should fail and no money will be deducted from your medical negligence compensation should you win your medical negligence claim.
Contact 5r1 Claims today to discuss your medical negligence claim. |
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NHS MANAGERS ARE LEGALLY RESPONSIBLE FOR CLINICAL NEGLECT-MEDICAL
Updated: 26 Sep 2011
NHS managers risk court over clinical errors
25 February, 2009 | By Dave West
NHS managers should be legally responsible for some clinical negligence cases, a patient safety expert has argued.
Brian Toft, a professor of patient safety at Coventry University and incident investigator, believes that where healthcare professionals have told managers about a problem with their care environment, the manager should be liable for incidents related to the problem.
He gave the example of clinicians complaining of being overloaded with patients and later making a mistake which harms someone.
Professor Toft, who has advised the World Health Organisation and the National Patient Safety Agency, said having formally told management about an issue could be used as a defence by a professional and as an argument to prosecute a manager.
"When you are under so much pressure you are absolutely going to make mistakes," he told HSJ.
"If the system of work forces people so they can't cope and therefore miss errors it shouldn't be the people who make the error who are held responsible, if they have already told their manager.
"They have to tell them formally in writing. If the manager takes no responsibility then it should be [the manager] that ends up in court."
Unsafe environment
Professor Toft said some investigations of major clinical errors in the past had blamed clinicians where the problem was really the fault of their environment.
But Managers in Partnership chief executive Jon Restell said: "Any employee who raises safety concerns is discharging their responsibility.
Managers are already responsible. Professionals still have a responsibility for their actions as well. I don't think managers are under any greater obligation [than before]."
An article by Professor Toft and Cardiff academic Peter Gooderham in the academic journal Quality and Safety in Health Care argues that if a manager ignores a warning from a professional, they are "consciously taking a risk which places the healthcare professional's patients in harm's way".
HSJ's Patient Safety Congress is on 30 April-1 May, visit www.patientsafetycongress.co.uk
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A CENTRE OF EXCELLENCE ? - MEDICAL
Updated: 23 Sep 2011
Better to go to a centre of excellence ?
Friday, 23 September, 2011 6:14
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Hospitals have got obsessed with success and failure rates.
So they exclude risk
Wards are empty
Lists are short
And people at risk suffer
But Surgery and Anaesthetics has always been a risky business
" The operation was a great success,unfortunately the patient died"
Procedures have improved and boundaries extended.
The question is :- do Hospitals care ?
Or do administrators rule ? -
THE ANSWER IS NO, WHAT IS THE QUESTION
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MEDICAL- COMPUTER WEBSITE SHOWS HOW THE BRAIN WORKS
Updated: 13 Sep 2011
Alzheimer's Research UK launches website showing how brains work
Organisation hopes to dispel the myth that dementia and Alzheimer's are inevitable parts of the ageing process by enabling people to explore the brain
- COMPUTER ACTIVE
- 08/09/2011
Website gives visitors a quick tour of the workings of the brain
Alzheimer's Research UK has launched an online interactive website in a bid to dispel the belief that dementia is a natural part of ageing.
The Brain Tour website explains how the brain works and the effects of Alzheimer's and other causes of dementia has on it, along with the symptoms these diseases cause.
The organisation said that as "well as being a fun way to explore this most mysterious of organs", developers at the charity believe the new tour could help break down a common misunderstanding - that dementia is an inevitable part of ageing.
Alzheimer's Research UK hopes to show that dementia is caused by diseases that affect the brain in specific ways and has been endorsed by Professor Julie Williams.
She is a leading geneticist and chief scientific advisor to Alzheimer's Research UK. Her discovery of the first new genes associated with Alzheimer's was one of Time magazine's scientific discoveries of 2009.
Professor Williams, said: "The brain houses our memories, thoughts and emotions, as well as controlling everything from our movements to sleep. It's also vulnerable to diseases like Alzheimer's and forms of dementia.
"The new Brain Tour gives everyone a chance to explore the different parts of the brain, but also to learn about how it can be affected by dementia. The Tour also showcases some of Alzheimer's Research UK's work and how it can be used to defeat dementia.
"Dementia is caused by diseases of the brain, but these diseases can be beaten with enough good research. We don't need to accept that dementia is inevitable, and we must support the fantastic, world-leading scientists we have in the UK in their battle to understand how dementia changes our brain."
Visitors to the site can also tweet or link information to Facebook and set up donations to help fund Alzheimer's Research UK research.
Read more: http://www.computeractive.co.uk/ca/news/2107936/alzheimers-research-uk-launches-website-brains#ixzz1XnmScyjz
Software, gadgets, magazines and more in our webstore. Click here to see our latest offers. |
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MEDICAL- DISTURBING RATE OF FAILURE AMONG SOME SURGEONS
Updated: 17 Aug 2011
Study reveals disturbing rate of failure among some surgeons
The study examined 250,000 bowel operations, and found one in 15 required further surgery
By Jeremy Laurance, Health Editor
INDEPENDENT ARTICLE
Wednesday, 17 August 2011
Thousands of patients are being forced to go under the knife for a second time because as many as half the operations carried out by some NHS surgeons end in failure.
The disturbing finding comes from a study of bowel surgery, one of the commonest operations carried out on the NHS. Patients whose bowel operations fail and have to be redone – usually because of bleeding, infection or leakage from the gut – face a four-fold increased risk of dying from surgery – up from 2.9 per cent to 11.9 per cent – and spend more than twice as long in hospital (27 days compared with 11). There is growing concern in the NHS over variations in the quality of care between NHS trusts and individual surgical teams and about how to improve the outcomes of the poorest performers.
Researchers from Imperial College, London, investigated re-operation rates following bowel surgery to discover how wide the variation was and what might be done to boost performance. They examined almost 250,000 bowel operations conducted between 2000 and 2008 in England.
Predictably, the results showed that the trusts performing the most operations had the best results. But even among these there were wide variations, with re-operation rates ranging from 3.7 per cent to 11.5 per cent.
Overall almost 16,000 patients required further surgery to correct something that had gone wrong – one in every 15 procedures. The study is published in the British Medical Journal. The worst-performing trusts and surgical teams are not named in the report, but an earlier study last April identified Burton Hospitals NHS Foundation Trust in Derbyshire as having the highest death rate following surgery for bowel cancer at 15.7 per cent, or one death in every 6.3 operations.
Omar Faiz, consultant colorectal surgeon and lead author of the study, said re-operation rates should be used with death rates to measure the quality of care in the NHS across a range of operations, provided the data was proved to be accurate. Re-operation rates of 50 per cent were rare and reflected very unusual circumstances, such as when non-specialist surgeons were required to operate in emergencies.
"If there really are differences in performance that can't be explained then the professional organisations will have to look at that," he said.
Professor Norman Williams, president of the Royal College of Surgeons said the overall re-operation rate (6.5 per cent) was "quite impressive" and compared well with other countries. "We shouldn't be complacent. If some surgeons truly have a 50 per cent re-operation rate it is extremely worrying."
The college had said specialist surgery should be centralised in fewer hospitals and had encouraged surgeons to monitor performance.
Katherine Murphy of the Patients Association said: "We are supposed to have an NHS with patients at the centre, but it is still far from a patient-led service. They might get a choice of hospital but they are never given details of individual consultant performance, except in cardiac surgery. If they can do it in cardiac surgery why can't we have it right across the NHS?
"These findings also emphasise the need for consultants to have regular tests ["revalidation"] by the General Medical Council to ensure they are up to date – but we are still waiting for it to be introduced," she added. |
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MEDICAL- JOKES -HOW ARE YOU TODAY DOCTOR ?
Updated: 12 Aug 2011
Subject: Fwd: Room 302
Anyone who has ever had a loved one in the hospital will enjoy this:
A woman called a local hospital. "Hello. Could you connect me to the person who gives information about patients. I'd like to find out if a patient is getting better, doing as expected, or getting worse."
The voice on the other end said, "What is the patient's name and room number?"
"Sarah Finkel, room 302."
"I'll connect you with the nursing station.
"3-A Nursing Station. How can I help you?"
"I'd like to know the condition of Sarah Finkel in room 302."
"Just a moment, let me look at her records. Mrs. Finkel is doing very well. In fact, she's had two full meals, her blood pressure is fine, she is to be taken off the heart monitor in a couple of hours and, if she continues this improvement, Dr. Cohen is going to send her home Tuesday at noon."
The woman said, "What a relief! Oh, that's fantastic... that's wonderful news!"
The nurse said, "From your enthusiasm, I take it you are a close family member or a very close friend!"
"Neither! I'm Sarah Finkel in 302. Nobody here tells me anything"
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MEDICAL- PRESCRIPTION MEDICINE UP 69% IN 10 YEARS
Updated: 28 Jul 2011
Prescription medicine up 69% in 10 years
Wednesday 27 July 2011
The number of medicines given out on prescription has jumped by almost 70 per cent in the last decade, NHS figures showed today.
In 2010, 927 million prescription items were dispensed in England, up 4.6 per cent on 2009 and 68 per cent above 2000 levels.
For every person in England an average of 17.8 prescription items were dispensed, compared to 17.1 in 2009 and 11.2 in 2000.
The average cost per head was £169 in 2010, compared to £165 in 2009 and £113 in 2000.
The highest number of drugs dispensed were for the cardiovascular system, while the most expensive bill was for drugs to treat disorders of the central nervous system.
High blood pressure and heart failure accounted for a high number of prescriptions, while drugs to treat diabetes were among the most costly.
The average cost per item was £9.53, down from £10.12 in 2000.
NHS Information Centre chief executive Tim Straughan said: "This report shows that on average people in England are receiving more prescription items than 10 years ago, although the average cost of each prescription item has decreased over the same period."
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MEDICAL - SCIENCE - MEN FIRING BLANKS
Updated: 22 Jul 2011
Male infertility linked to protein invisibility cloak
Sperm wears a protein coat that helps it sneak past the female immune system – or it should.
Going coatless could be a major cause of male infertility, as it leaves sperm less able to penetrate the female's cervical mucus and fertilise the egg.
Infertility, defined as the inability to conceive after 12 months of unprotected intercourse, affects 10 to 15 per cent of couples globally.
About half of the time it is the male partner who is infertile – but in seven out of 10 cases of male infertility, sperm count and quality remain high, and the cause of the problem remains a mystery.
A new study offers one possible explanation. Gary Cherr at the University of California, Davis, and colleagues studied 500 newly married Chinese couples.
They found that when men's sperm lacked a coat of the protein beta-defensin 126, their wives were significantly less likely than expected to become pregnant.
They were also 30 per cent less likely to give birth when they did.
There is already some evidence that mouse and non-human primate sperm lacking the protein is less able to pass undetected through the female reproductive tract to fertilise an egg; Cherr thinks this cloaking role applies in human sperm too.
"It has always been an enigma in biology why sperm cells in the female tract are not recognised as foreign cells and subsequently destroyed," he says. "We now know this protein coat helps the sperm cells evade the female's natural surveillance mechanisms."
Unwrapped sperm
Cherr's team was able to identify a genetic mutation as the cause of this protein coat defect.
The mutation, known as DEFB126, is recessive and may be carried by almost half of all men.
Up to a quarter of men may have two copies of the mutant gene, meaning that they produce sperm without the vital protein coat.
"However, this does not mean that they are necessarily infertile," points out Edward Hollox at the University of Leicester, UK, another member of the research team.
He says that these men are likely to experience "reduced fertility" and should simply try for longer before resorting to other methods, such as IVF.
Cherr claims that the identification of this mutation could save couples months of going through tests to identify the cause of infertility.
"Diagnosis of this mutation becomes very straightforward – it could be as easy as going to your local doctor's surgery and spitting into a cup." Cherr also hopes that his team's discovery could lead to the future development of cures for this type of infertility.
"Recombinant DNA could be used to alter the sperm – one day this could even perhaps take the form of a home kit."
Journal reference: Science Translational Medicine, DOI:
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MEDICAL-MEDICAL CONSENTS CAMPAIGN
Updated: 11 Jul 2011
MEDICAL CONSENTS – CAMPAIGN -JULY 2011
TO SEPARATE CONSENT FORMS
FOR SURGICAL OPERATION AND ANAESTHETIC
(“THE OPERATION WAS A GREAT SUCCESS UNFORTUNATELY THE PATIENT DIED”
OR
“DOCTORS BURY THEIR MISTAKES”)
I RECENTLY HAD SURGERY UNDER A GENERAL ANAESTHETIC.
I SIGNED ONE CONSENT FORM FOR BOTH.
I AM CAMPAIGNING THAT A CONSENT FORM BE GIVEN FOR EACH SEPARATELY.
I AM ALSO DEMANDING THAT THE PATIENT RECEIVE A COPY OF WHAT HE OR SHE HAS SIGNED.
( IN THE CASE OF A MINOR - THE GUARDIAN ACTS)
THIS DID NOT HAPPEN IN MY CASE EITHER!
THE SURGICAL CONSENT FORM CONSENTS TO THE OPERATION PROCEDURE TO BE UNDERTAKEN AFTER IT HAS BEEN EXPLAINED BY A MEMBER OF THAT SURGICAL TEAM.
BECAUSE THE SURGEON AND ANAESTHETIST ARE DIFFERENT “TEAMS” WITHIN THE HEALTH SERVICE AND BECAUSE EACH ARE UNDERTAKING POTENTIALLY LIFE THREATENING PROCEDURES,BOTH TEAMS SHOULD EXPLAIN, DISCUSS AND CONFIRM THEIR PROCEDURE BY “CONSENT”.WITH THE PATIENT.
IN THIS DAY WHEN LIFE IN CURRENT SOCIETY AND ITS HEALTH CARE IS CONSIDERED CHEAPER THAN IT OUGHT TO BE, THE THREAT OF LITIGATION IS EVER MORE REAL AGAINST AUTHORITY.
LET ME EXPAND ON MY DEMAND.
I WAS SEEN BY THE SURGICAL TEAM WHO EXPLAINED THE PROCEDURE AND RISKS OF THE OPERATION
INCLUDED ON THIS FORM WAS THE CONSENT TO ANAESTHETIC
SO I WAS, IN FACT BEING ASKED TO SIGN A CONSENT FORM FOR THE GENERAL ANAESTHETIC BEFORE SEEING AN ANAESTHETIST.
YOU MAY SAY THIS SHOULD BE UNNECESSARY BUT…
THERE ARE ISSUES WHICH THE PATIENT AS MUCH AS THE DOCTOR WANT MADE QUITE CLEAR.
I WANTED TO REFUSE A SPINAL ANAESTHETIC BECAUSE I HAVE A DEGENERATIVE SPINAL DISC LESION.
APPARENTLY IN MY CASE THE ANAESTHETIST DID NOT KNOW THIS BECAUSE HE HAD NOT READ ALL MY NOTES.
BUT BECAUSE I AM WHO I AM I CAN SPEAK FOR MYSELF.
AND HE ACCEPTED THIS WHEN I MADE THE SITUATION CLEAR.
OTHERS MAY HAVE DIFFICULTY TALKING TO OR UNDERSTANDING MEDICAL JARGON AND BLINDLY AGREE TO PROCEDURES THEY UNDERSTAND LITTLE ABOUT WHICH LEAD ON TO COMPLICATIONS.
WORSE, THEY MAY NOT EVEN HAVE AN OPTION TO THE TYPE OF ANAESTHETIC BEING USED.
IT COULD BECOME LESS OF A CONSULTATION
AND MORE A “DOCTOR KNOWS BEST”
BLIND FAITH ?
THIS WILL NOT DO.
THE MEDICAL STAFF ALSO NEED TO INVOLVE TRAINED NURSING STAFF TO MAKE QUITE SURE THE PATIENT UNDERSTANDS WHAT THEY ARE SIGNING, FROM WHAT THEY ARE BEING TOLD.
YES – IT DOES TAKE TIME BUT “ACCIDENTS” HAPPEN OR RATHER THEY ARE NOT ACCIDENTS BUT SOMEONE’S FAULT.
IN THIS CASE THE ANAESTHETIST MADE LOTS OF NOTES ABOUT MY MEDICAL CONDITIONS AND WANTED TO KNOW – FROM ME- WHY I HAD A PACEMAKER FITTED.
WAS IT THAT MY IRREGULAR RHTHYM WAS REGULAR OR IRREGULAR, I ASKED ?
BETTER CHECK WITH EXPERTS !
SO I WAS ABLE TO REFER HIM TO THE CARDIOLOGY DEPT WHERE MY PACEMAKER IS CHECKED EVERY SIX MONTHS.
BUT WHATEVER NOTES HE MADE, I WAS NOT ASKED TO SIGN A CONSENT FORM, RECEIVE A COPY OF WHAT HE WROTE OR EVEN HEAR THAT HE HAD REFUSED TO ANAESTHETISE ME.
I SHOULD KNOW THAT TOO ?
THAT COULD HAVE BEEN AN OPTION ?
REFUSAL TO CONSENT TO GIVE AN ANAESTHETIC ?
WITH AN EXPLANATION FORM
BUT I HAD ALREADY GIVEN MY CONSENT !
DOES THAT NOT MAKE YOU THINK ?
WILL YOU SUPPORT MY CAMPAIGN ?
"Get in Touch"
THE RADICAL
CC
LIZ KENDALL MP SHADOW HEALTH SEC.
BMA
NHS PROTECTION AGENCY
NHS LITIGATION AUTHORITY
MEDICAL HEALTH REGULATORY AUTHORITY -MHRA
GMC
UNISON
RCN NURSING STANDARD
NURSING TIMES
SOCIALIST HEALTH ASSOC.
BCM LONDON HEALTH EMERGENCY
PATIENTS ASSOC
NHS TRUST ASSOC
MEDICAL DEFENCE UNION
DAILY TELEGRAPH
STEPHEN PHILLIPS MP
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MEDICAL- KNEE REPLACEMENT/ARTHROPLASTY
Updated: 06 Jul 2011
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Knee Replacement / Knee Arthroplasty
THE PHYSIOTHERAPY SITE
Knee replacement or knee arthroplasty is the orthopaedic operation in which a diseased, worn or injured knee joint is replaced by an artificial joint. Knee replacements are now a routine operation, most commonly performed due to knee arthritis. It is an established, generally accepted medical intervention with predictable results from skilled orthopaedic surgeons.
This video shows the components which are inserted during a knee replacement, using a Scorpio knee.
The National Joint Registry, which collects statistics on all the joint replacements performed in Britain, shows that in 2010 in England and Wales there were over 56,000 knee replacements performed in the NHS and over 24,000 in independent hospitals with the vast majority of people being over sixty-five years old and somewhat over half of these being female.
Two main forms of replacement knee are performed: a whole or total knee replacement if the joint damage is widespread and a partial knee replacement if the joint damage is confined to one side of another of the joint.
As with hip replacement, knee replacements have a limited life span but can last from 15 to 20 years if they are well looked after and not put under undue physical stresses and strains. Revision knee replacement, where the surgery is done again for a problem or due to the joint reaching the end of its life, is a longer and more complex surgical matter than initial replacement and in general people are less pleased with their new knee each time it is redone.
Reasons for Having a Knee Replacement
Knee replacement is a major operation with all the risks and complications which go with such knee surgery. You may feel you need a knee replacement if you have these difficulties:
- You have severe knee pain which interferes with the quality of your life
- Your knee pain interferes with your sleep
- Physiotherapy and medication has not been effective or caused side effects
- You have having increasing difficulty with everyday tasks such as going shopping or self care
- The pain and loss of mobility are making you feel down and depressed
- You are unable to have a reasonable social life or to work.
The knee is a large hinge joint and is made up of two joints overall. The much larger joint is the true knee joint between the rounded bottom end of the thigh bone and the flattened top of the shin bone, the smaller one being between the rounded bottom end of the thigh bone again and the back of the kneecap.
A firm, slippery and low friction material called articular cartilage or joint cartilage covers the surfaces of the joint and along with the fluid secreted by the lining membrane allows the easy movement of a joint even when it is loaded.
As the cartilage becomes worn or damaged the free and easy movement is lost and in severe cases the underlying bone is exposed and grates against the other side of the joint, causing pain and disability. Osteoarthritis is the commonest cause of this problem and the most common reason for performing knee replacement.
Knee Arthroplasty
The components which make up the knee prosthesis are made up of a specialised stainless steel and a high density polyethylene. See the parts which make up an artificial knee joint here. Partial knee replacement may be used to replace just one of the sides of the joint, called a compartment, if the arthritis is confined to that side only. Knee replacement cost is high and partial replacement can reduce the costs by around £1700 or more
Knee Replacement Procedure
If you are planning on having a total knee replacement surgery you can read a short description of the knee replacement operation here. Depending on the type of clinical problem the orthopaedic surgeon finds, he or she can choose from various types of knee replacement surgery, with the main decision being between total knee replacement which replaces the entire articulating surface of the knee joint and kneecap and unicompartmental knee arthroplasty (partial knee replacement).
Knee Surgery Rehab
Unlike hip replacement, knee replacement demands a lot in terms of effort and you have to put up with more pain and swelling, do far more exercising for far longer and it may take three months or so for the knee to settle down. This means that it is important to prepare for knee replacement surgery, for instance by seeing the physiotherapist so your knee can be assessed and advice and exercises given. Find out what rehabilitation and knee replacement exercises you need to do.
After Knee Replacement
Towards the end of your hospital stay and afterwards read what should you expect on discharge.
A joint replacement is for life, not just for the short time you are with us. How you are monitored during the years ahead is vital and you can read here that kind of follow up you should expect. Knee replacement complications are common but most are minor and easily treated and ideally you should be able to forget about your new joint in daily life, but it is not like the original joint. You need to take some precautions for a sensible long life of coexistence with your joint. Read how to look after your new joint here.
Knee Replacement Complications
Due to the complexity of the operation and the necessity for you to participate fully in your operation and the following rehab with the physiotherapist it is very useful to have good knee replacement surgery information. This way you can review the knee replacement surgery risks and knee replacement complications and will benefit from useful media such as a partial knee replacement surgery video. There is a lot of information to take in about all aspects of the operation and recovery and there is useful additional information and a knee replacement animation at the NHS Choices website and Wikipedia has a page with many knee replacement links.
However, nothing will quite give you the understanding of the knee surgery you are about to have more than a knee replacement surgery video, especially the longer ones at half an hour or so. They have still been edited down to shorter times but include all the important steps which the surgeon goes through and show some of the reasons for the relatively long period of knee replacement recovery which follows this operation.
Signature Knee Replacement
Customised knee replacements are being developed to allow for the fact that many people, especially women and those with smaller or unusually shaped joints. Biomet has developed the Signature knee replacement system which uses MRI scanning to give a 3D image of the individual's knee to allow more precise operation planning. From the scan the system allows manufacture of alignment guides for the operation which can be used without being as invasive as normal alignment systems.
Hip Replacement
Hip replacement has similar issues to knee replacement, including the types of hip replacement available, hip replacement costs being less than knee replacement, the choice between hip replacement and hip resurfacing and the use in broken hip or fractured neck of femur.
Watching videos of the procedures is a very good way of understanding what's going on and enables patients to participate fully in their rehabilitation with the physiotherapist. Go to hip replacement video for more information.
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MEDICAL- THE "CODE OF SILENCE" IN THE NHS IS UNACCEPTABLE
Updated: 05 Jul 2011
Doctors call for code to protect whistleblowers
RADICAL SAYS- ITS NOT ONLY DOCTORS WHO BURY THEIR MISTAKES.
COVER UPS - ITS ENDEMIC- FROM MP'S TO HOSPITAL TRUST CHIEFS TO INDUSTRY BOSSES IN HEALTH AND SAFETY-
By Nina Lakhani
Tuesday, 5 July 2011
INDEPENDENT ARTICLE
Pressure is mounting on Government ministers to introduce tougher laws to protect whistleblowers as health professionals and MPs speak out against a "code of silence" in the NHS.
A group of leading doctors are urging the government in this month's Journal of the Royal Society of Medicine (JRSM) to consider US-style protection systems which have improved the plight of whistleblowers since the Enron financial scandal.
American whistleblowers are entitled to a proportion of fines imposed on employers who punish or silence employees. In contrast, UK managers and bosses appear to operate with immunity while whistleblowers often face unemployment and financial hardship even when vindicated in court.
Dr Peter Wilmshurst, co-author of the JRSM paper, says the huge financial cost of fighting an unfair dismissal in the UK acts as a powerful deterrent for colleagues left behind.
"People know that whistleblowers do not do well in the NHS. This is a political problem that no minister is prepared to deal with but it is also a cultural problem within the profession. There is a code of silence and so those who do talk about problems are considered aberrant. There is no doubt there is a knock-on effect for all those left behind who get too frightened to stand up and speak out."
Last year, Ramon Niekrash, a surgeon from South London Healthcare NHS trust who was suspended after reporting patient safety breaches at Queen Elizabeth Hospital, before it merged to form a new supertrust, was left with a £180,000 legal bill despite winning his employment tribunal.
A senior surgeon from the trust told The Independent that "things are out of control here, someone needs to do something". Another surgeon said: "After Ramon, there has been a general feeling of fear and most people will not complain or take a stand... the doctors are totally de-motivated."
The trust said there was "no question" of any staff member facing any consequence as a result of raising concerns.
Dr Stephen Bolsin, co-author of the JRSM paper, who exposed high death rates among babies with cardiac problems at Bristol Royal Infirmary in 1995, was forced to move to Australia after being ostracised by the NHS. His case triggered the 1998 Public Interest Disclosure Act, but doctors say it has "not been as effective as anticipated".
John Pugh, chair of the Lib Dem health policy group, welcomed the Health Select Committee inquiry, revealed in The Independent yesterday, and said he would ask the Health Secretary to consider the US model for protecting whistleblowers. "It's time to blow the whistle on whistleblowers and provide them with protection that works," he said.
A Department of Health spokesperson said recent changes made to the NHS contract would help but "there is already strong legal protection for whistleblowers and it is clear that people who have been subject to detriment are able to seek redress".
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MEDICAL- SORE THROAT AFTER GENERAL ANAESTHETIC
Updated: 01 Jul 2011
Sore throat
RADICAL SAYS - SORE THROAT OR LARYNGEAL ODEMA ?
HOW DIFFICULT IS SWALLOWING ?
IF YOU CAN'T SWALLOW OR BREATHE EASILY
SEE YOUR GP OR DIAL 999
Section 2: Sore throat
Why does a sore throat happen?
During any general anaesthetic your
anaesthetist must make sure that you can
breathe freely. He/she must also make
sure that secretions or stomach contents,
which can collect in your throat during an
anaesthetic, do not get into your trachea
(windpipe) or your lungs.
Your anaesthetist will choose one of
several methods to achieve these things
after you are anaesthetised. The choice
will depend on your medical condition
and on what operation you are having.
He or she may use the following.
4 A face mask: This is held firmly
onto your face by your anaesthetist.
Sometimes a separate plastic Guedel
airway that sits over the tongue is
needed as well.
4 A laryngeal mask airway: This
is a different shaped tube, with a
soft cuff, which sits in the back of
the throat above the opening to the
trachea. When in place it allows gases
to move freely in and out of the lungs
but it does not protect the lungs from
secretions or stomach contents. It is
not suitable for some operations.
4 A tracheal tube: This is positioned
in your trachea (windpipe) and has a
soft cuff, which is inflated to prevent
leakage of gases or movement of
secretions.
During your anaesthetic it is occasionally
necessary to use an additional tube placed
in your nose or mouth to empty your
stomach. All of these tubes or masks are
placed after you are anaesthetised and
you are not usually aware of their use.
However, any of them may contribute to a
sore throat as follows.
4 During insertion, any of the tubes or
equipment used to insert them in the
mouth may cause irritation or damage
to your throat.
4 The tracheal tube and the laryngeal
mask airway both have a cuff, which
may press on parts of your throat
or airway causing swelling and
discomfort.
4 Anaesthetic gases and some drugs
can dry your throat. This may also
contribute to a sore throat following
your anaesthetic.
Uncommonly, placement of an airway
tube is difficult. It is possible that more
significant damage to the vocal cords and
other structures can occur occasionally in
these circumstances.
How likely is it to occur?
After a general anaesthetic with a tracheal
tube the risk of developing a sore throat is
estimated to be around 2 in 5.1–3
After a general anaesthetic with a laryngeal
mask airway the risk is estimated at about
1 in 5.1
After a general anaesthetic you may develop a sore throat. This can
range between a minor discomfort and a more severe continuous pain.
You may also have a very dry throat or feel pain on speaking or swallowing.
These symptoms may disappear after a few hours but may take two days or
more to settle down. Recent advances in anaesthetic equipment mean that
having a very sore throat is less common than before.
2 Risks associated with your anaesthetic
Section 2:
Sore throat
Authors
David Murphy
Medical Student
Southampton School of Medicine
Dr Lucy A White, MA, MRCP, FRCA
Consultant Anaesthetist
Southampton University Hospital Trust
Editor
Dr Tim Smith, MD, FRCA
Consultant Anaesthetist
Alexandra Hospital, Redditch
Primary FRCA Examiner
References
1 Higgins PP, Chung F, Mezei G. Post operative
sore throat after ambulatory surgery. Br J Anaesth
2002;88:582–584.
2 Tanaka Y et al. Lidocaine for preventing postoperative
sore throat. Cochrane Database of2009, Issue 3.
Systematic reviews
3 Biro P, Seifert B, Pasch T. Complaints of a sore
throat after tracheal intubation: a prospective
evaluation. Europ J Anesth 2005;22(4):307–311.
4 Sumathi P et al. Controlled comparison between
betamethasone gel and lidocaine jelly applied
over tracheal tube to reduce post operative sore
throat, cough and hoarseness of voice. Br J Anaesth
2008;100(2):215–218.
v Information for Patients: The Royal College of AnaesthetistsRisks associated with your anaesthetic
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MEDICAL- BETTER PATIENT CARE BY GP'S FINANCIALLY REWARDED
Updated: 30 Jun 2011
GP bonuses 'lead to poor patient care' as financial incentives boost some treatments... but cause a decline in others
By Jenny Hope
Last updated at 10:52 AM on 29th June 2011
Bonus payments for GPs mean some patients are missing out on improved care, say researchers.
The financial incentives have led to better measuring of high blood pressure and cholesterol levels, a study shows.
But in other areas of patient care which are not in the scheme improvements were ‘significantly below’ what was expected.
Bonuses: GPs started receiving money for meeting targets in 2004, but this has since led to significant improvements in treatments that were in the scheme, while care quality in those that were not has dropped
These included measurements involving people suffering from arthritis, dementia and back pain.
Pay-for-performance targets were introduced in 2004 as part of a new contract for GPs to reward them for taking better care of patients.
The scheme had an annual price tag of £1.8billion at the time and is now worth around £1billion.
Around a quarter of GPs’ average income – currently £105,000 a year – is linked to achieving the targets.
But the study says there may be ‘unintended consequences’ to the scheme, which is known as the Quality and Outcomes Framework. The study, published last night in the British Medical Journal, looked at data from 500 UK general practices and trends in quality of care for 42 activities.
Of these, 23 measurements or treatments attracted a bonus payment including measuring blood pressure and smoking habits.
A further 19 activities did not lead to extra money, including measurement of thyroid function or blood sugar levels in certain categories of patients.
For all activities, there was a general improvement in quality before incentives were introduced.
Improvement: Blood pressure measurement was one of the areas where doctors received an incentive - leading to an increase in the quality of treatment
When bonuses were attached to some measurements, there was a significant increase in quality during the first year after the scheme came in.
This levelled off after three years to a 4 per cent rise above what would have been expected without incentives.
For measurements that did not attract extra money, quality was ‘significantly worse’ after three years, with a 5 per cent drop compared with the improvement that would have been expected without incentives.
Dr Tim Doran, who led the research team, said financial incentives resulted in a quicker rate of improvement in some activities.
But it was questionable whether this lasted, and whether patients whose conditions did not attract bonuses were being neglected.
Dr Doran, a clinical research fellow at Manchester University, said: ‘It’s not possible to incentivise everything. It does improve quality in the short to medium term but it has a small detrimental effect on activities that do not attract financial targets.
‘In the medium term these may have been slightly neglected.’
Dr Doran said there were limitations to ‘bonus’ schemes because they set priorities for care that might result in other areas such as depression receiving less attention, partly because it was harder to measure improvements. Earlier this year research found that targets set to improve high blood pressure and cut heart attacks and strokes ‘had no impact’.
Researchers, led by Dr Brian Serumaga, a Harvard Medical School fellow working at Nottingham University, investigated 470,000 patients with high blood pressure. They found ‘little evidence’ of effectiveness of pay for performance targets.
The Government has pledged to reform the way GPs are paid for targets in the face of criticism.
The British Medical Association says the Quality and Outcomes Framework was designed to ensure that patients received uniform high-quality care no matter where they lived in the country, and, by doing that, to improve public health over the long term.
A Department of Health spokesman said: ‘The Quality and Outcomes Framework and other incentives for GPs are insufficiently focused on outcomes, including patient experience.
‘We therefore intend to reform the payment system so that GPs are rewarded appropriately for improving patient outcomes.’
Read more: http://www.dailymail.co.uk/health/article-2009272/GP-bonuses-lead-poor-patient-care.html#ixzz1Qlq8BXyI |
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MEDICAL- CINNAMON CAN DELAY ALZHEIMERS DEVELOPMENT, SAYS STUDY
Updated: 30 Jun 2011
Cinnamon can delay development of Alzheimer’s, according to study
Published 29 June 2011
An extract found in cinnamon bark, called CEppt, contains properties that can delay the development of Alzheimer's disease, according to a study published in the journal PloS One.
The research team at Tel Aviv University tested CEppt on mice that were raised with five aggressive strains of Alzheimer's-inducing genes.
When given water containing a CEppt solution over four months, researchers found that the ingredient inhibited the formation of toxic amyloid plaques and also prevented these plaques from killing brain cells in the mice. Amyloid plaques are a major hallmark of Alzheimer's disease.
Alzheimer's Society comment
'This is an interesting study which looks at the benefits of a specific ingredient in cinnamon. However people shouldn't rush out to buy this popular spice. This research is in the early stages and looked at mice not humans. We are therefore a long way from using cinnamon in the fight against Alzheimer's. We need greater investment in dementia research to help us translate potential opportunities like this into effective treatments for people living with this devastating condition.'
Professor Clive Ballard
Director of Research
Alzheimer's Society
Research Reference:
Michael Ovadia et al. 'Orally Administrated Cinnamon Extract Reduces β-Amyloid Oligomerization and Corrects Cognitive Impairment in Alzheimer's Disease Animal Models' published in PloS One, January 2011 |
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MEDICAL- DRUG COMBINATION PROBLEMS
Updated: 30 Jun 2011
New Study: Combining Commonly Used Drugs Linked to a Greater Risk of Death and Declining Brain Function
The findings of a new study published in the Journal of the American Geriatrics Society further support the importance of having your doctor regularly review your prescription and over-the-counter (OTC) medicines to ensure the additive risks of side-effects do not outweigh the benefits.
This study specifically looked at prescription and over-the-counter medicines that are known to affect a chemical in the brain called acetylcholine. Acetylcholine is important for passing messages from nerve cell to nerve cell, but many common drugs interfere with it as a side effect. Medicines that block acetylcholine activity have the potential to cause side effects such as constipation, drowsiness, confusion, memory problems, difficulty thinking or focusing, dry mouth, blurred vision, dizziness, and slowing of urination. Examples of medicines with anticholinergic activity and a potential to cause these side effects include antidepressants such as amitriptyline, imipramine and clomipramine (Anafranil, Anafranil SR), tranquilizers such as chlorpromazine (Chloractil, Largactil) and trifluoperazine (Stelazine), bladder medication such as oxybutynin (Cystrin, Ditropan, Lyrinel XL, Kentera), and antihistamines such as chlorphenamine (Piriton) and diphenhydramine (Benadryl).
In the current study, eighty medicines were rated for their "anticholinergic" activity. They were ranked 0 for no effect, 1 for a mild effect, 2 for a moderate effect, and 3 for a severe effect. A combined score was calculated in 13,000 patients aged 65 or over, by adding together the scores for all the medicines they were taking. The study found that participants with a medicine score of four or more were at an increased risk of death compared to patients taking no anticholinergic drugs. Those taking medicines with a combined score of five or more had lower scores on a cognitive function test which supports previous research showing a possible link between anticholinergic medicines and problems with thought processes.
To see a list of the eighty medicines included in this study, please visit:
http://www.mediguard.org/r/06niGDPqB82
For more information, please visit:
http://www.mediguard.org/r/0snmQ6PtueW
****
WHAT DOES THIS MEAN?
It is important not to jump to conclusions about this new study. This study cannot say that the anticholinergic medicines caused death or reduced brain function - the study merely suggests that there was an association. Further research is needed to understand possible reasons for this link.
This alert is a good reminder for you to attend your routine doctor's appointments for regular monitoring of your health. Since some over-the-counter (OTC) medicines have anticholinergic side effects, be sure your doctor is aware of all of the medicines and supplements you are taking. Doctors are aware of the risks of combining different drugs and it is a good idea to ask your doctor to regularly review any medicines you take routinely and as needed, including any OTC products.
Please do not panic or stop taking your medicine(s). If you have any concerns about your current medicines, please continue taking your medicines and follow up with your own doctor or pharmacist to discuss your concerns.
For updated risk ratings on all of your registered medicines, or to update your medicine list, please log into your profile (https://uk.mediguard.org/user).
You can also reach your profile by clicking on the link in the top right corner of any page on our website.
****
PLEASE TELL YOUR FRIENDS
We want to continually improve our service, and hope you want to help us too.
Please reply with any suggestions, ideas, comments or feedback that we can use to make our service more valuable for you... And don't forget to tell your friends and family about what we do!
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MEDICAL- HIGHER DOSES OF STATINS MAY CAUSE DIABETES
Updated: 30 Jun 2011
New Study Suggests High-Dose Statins May Cause Diabetes
A new study published in the Journal of the American Medical Association (JAMA) suggests that taking higher doses (80mg) of two types of widely prescribed statins - simvastatin or atorvastatin - increases the chance of developing Type 2 diabetes over five years, compared to taking moderate dose statins (20mg or 40mg).
The researchers remain unclear about how statins work to trigger diabetes in some individuals. It could be possibly related to how statins affect muscle or liver insulin activity. Another explanation for increased diabetes in patients on high dose statin therapy may be because more patients at risk for diabetes are surviving due to the benefits of statins. More research is needed to confirm this study's findings.
Atorvastatin is available under the brand name Lipitor. Simvastatin is available as a generic product and under the brand names Zocor, Simvador, and also in the combination product Inegy.
For more information, please visit:
http://www.mediguard.org/r/0oLbich4udw
****
WHAT DOES THIS MEAN?
It is important not to draw too many conclusions from this study. Statins continue to be effective in lowering levels of cholesterol and reducing the risk of heart attacks and strokes. The increased diabetes risk identified in this new study is very small and the benefits of statins continue to outweigh the risk of side effects for most patients.
If you take a simvastatin or atorvastatin product (Zocor, Simvador, Inegy, Lipitor), you should continue to take your medicine as directed. This alert is a good reminder for you to attend your routine doctor's appointments for regular monitoring of your health and talk to your doctor if you have any concerns.
For updated risk ratings on all of your registered medicines, or to update your medicine list, please log into your profile (https://uk.mediguard.org/user).
You can also reach your profile by clicking on the link in the top right corner of any page on our website.
****
PLEASE TELL YOUR FRIENDS
We want to continually improve our service, and hope you want to help us too.
Please reply with any suggestions, ideas, comments or feedback that we can use to make our service more valuable for you... And don't forget to tell your friends and family about what we do!
DISCLAIMER
MediGuard is not intended to be a substitute for professional medical advice. MediGuard cannot and does not take into consideration every possible interaction or account for individual responses to medicine. Different individuals may respond to medicine in different ways. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective, or appropriate for any given patient. Always seek the advice of a qualified health provider with any questions you may have before making any changes to your treatment. The use of the MediGuard site and its content is at your own risk. (c) 2011 iGuard, Inc. All rights reserved. MediGuard, iGuard, Inc. c/o Quintiles Ltd, Station House, Market Street, Bracknell, Berkshire, RG12 1HX
For more information about MediGuard, please visit: http://uk.mediguard.org
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MEDICAL- KNEE ARTHROSCOPY
Updated: 28 Jun 2011
Knee arthroscopy
THE RADICAL IS HAVING ONE TODAY, SO THERE WILL BE NO RIGHTS AND WRONGS TOMORROW ONLY RECOVERY ?
Published by Bupa's Health Information Team, December 2010.
This factsheet is for people who are planning to have a knee arthroscopy, or who would like information about it.
Knee arthroscopy is a type of keyhole surgery, used to look inside and treat the knee joint.
You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.
About knee arthroscopy
You may have knee arthroscopy to investigate problems such as inflammation or injury, or to repair damaged tissue and cartilage. It’s also used to take small tissue samples (biopsies), which can help to diagnose problems such as infection.
Knee arthroscopy is performed through small cuts in your skin, using a special telescope (arthroscope) attached to a video camera. Compared with open surgery, arthroscopy has a faster recovery time.
What are the alternatives?
Not everyone who has a knee problem needs to have an arthroscopy. Your doctor may diagnose your knee problem using physical examination, an X-ray or an MRI scan. An MRI scan uses magnets and radiowaves to produce images of the inside of your body. Some problems can be treated using physiotherapy and medicines.
Preparing for a knee arthroscopy
Your surgeon will explain how to prepare for your operation. For example if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
The operation is usually done as a day case under general anaesthesia. This means you will be asleep during the procedure. Alternatively you may have the surgery under local or regional anaesthesia. This completely blocks the pain from the knee area and you will stay awake during the operation. Your surgeon may offer you a sedative with a local or regional anaesthetic, which relieves anxiety and helps you to relax during the operation.
If you're having general anaesthesia, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your anaesthetist’s advice.
At the hospital your nurse may check your heart rate and blood pressure, and test your urine.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
You may be asked to wear a compression stocking on the unaffected leg to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.
What happens during a knee arthroscopy
An arthroscopy can take from 30 minutes to over an hour, depending on how much work your surgeon needs to do inside your knee joint. Once the anaesthetic has taken effect, your surgeon will make small cuts in the skin around your knee joint. He or she will pump sterile fluid into your joint to help produce a clearer picture and then insert the arthroscope.
Your surgeon will examine your knee joint by looking at images sent by the arthroscope to a monitor. If necessary, he or she can insert instruments to repair damage or remove material that interferes with movement or causes pain in your knee.
Afterwards, your surgeon will drain the fluid out and close the cuts with stitches or adhesive strips. Then he or she will wrap a dressing and a bandage around your knee.
What to expect afterwards
You will need to rest until the effects of the anaesthetic have passed. It may take several hours before the feeling comes back into your knee. Take special care not to bump or knock the area.
You may need pain relief to help with any discomfort as the anaesthetic wears off.
You will usually be able to go home when you feel ready.
You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment. A physiotherapist should also visit you to help get your joint moving and discuss exercising at home.
The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure they should usually disappear in about six weeks. Non-dissolvable stitches are removed 10 to 14 days after surgery.
Recovering from knee arthroscopy
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.
Some people may have to wear special pads, attached to an intermittent compression pump, on their lower legs. The pump inflates the pads and encourages healthy blood flow in your legs and helps to prevent DVT.
You may also be wearing compression stockings on your unaffected leg to help maintain circulation.
You will have a dressing and an elasticated bandage over your knee joint. These apply pressure to assist with healing. You need to keep your knee clean and dry for about one to two weeks. You should use waterproof plasters over your healing wounds when you take a shower and don't soak your knee in the bath until the cuts are fully healed.
Continue with the exercises recommended by your physiotherapist, as they will help to improve your knee movement and strength.
Your knee joint is likely to feel sore and swollen for at least a week. This can last longer if you have arthritis. Try to keep your leg raised on a chair or footstool when you're resting. You should apply a cold compress such as ice or a bag of frozen peas, wrapped in a towel, to help reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage your skin.
Follow your surgeon's advice about driving. You shouldn't drive until you're confident that you could perform an emergency stop without discomfort. This is usually about one to three weeks after your operation.
Your recovery time will depend on what, if any, treatment your surgeon performs on your knee joint. You should be able to resume your usual activities after six to eight weeks depending on the severity of your knee problems and your level of fitness.
What are the risks?
Knee arthroscopy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
Side-effects
These are the unwanted, but mostly mild and temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic.
After a knee arthroscopy you will have small scars on your knee from the cuts.
Complications
This is when problems occur during or after the operation. Most people aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, a wound infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (DVT).
Arthroscopy complications can include:
- accidental damage to the inside of your joint
- infection
- loss of feeling in the skin over your knee
- bleeding into your joint
- the surgery may not be successful or it may have to be repeated
The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.
For answers to frequently asked questions on this topic, see Common questions.
For sources and links to further information, see Resources.
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MEDICAL - DIAGNOSTIC ARTHROSCOPY
Updated: 22 Jun 2011
Diagnostic arthroscopy
The surgeon uses a rigid arthroscope, a tube of 5 - 6 mm in diameter with fiber optic to examine the knee joint.
The artroscope is introduced into the knee joint through very small incisions. Usually, the arthroscope is coupled to a vide TV screen.
The whole examination may be also recorded on a video band.
The examination is done in anesthesia.
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MEDICAL - A KNEE CT SCAN
Updated: 22 Jun 2011
A computed tomography (CT) scan of the knee is an imaging method that uses x-rays to create detailed pictures of the knee.
How the Test is Performed
You will be asked to lie on a narrow table that slides into the center of the CT scanner. You will lie on your back.
Once you are inside the scanner, the machine's x-ray beam rotates around you. (Modern "spiral" scanners can perform the exam in one continuous motion.)
Small detectors inside the scanner measure the amount of x-rays that make it through the knee. A computer takes this information and uses it to create several individual images, called slices. These images can be stored, viewed on a monitor, or printed on film. Three-dimensional models of the knee can be created by stacking the individual slices together.
You must be still during the exam, because movement causes blurred images. You may be told to hold your breath for short periods of time.
The test should take less than 1 hour.
How to Prepare for the Test
Certain exams require a special dye, called contrast, to be delivered into the body before the test starts. Contrast can highlight specific areas inside the body, which creates a clearer image.
Some people have allergies to IV contrast and may need to take medications before their test in order to safely receive this substance.
Contrast can be given several ways:
- It may be delivered through a vein (IV) in your hand or forearm.
- You might drink the contrast before your scan. The contrast liquid may taste chalky, although some are flavored to make it taste a little better. The contrast eventually passes out of your body through your stools.
If contrast is used, you may also be asked not to eat or drink anything for 4-6 hours before the test.
If you weigh more than 300 pounds, have your doctor contact the scanner operator before the exam. CT scanners have a weight limit. Too much weight can cause damage to the scanner's working parts.
Since x-rays have difficulty passing through metal, you will be asked to remove jewelry and wear a hospital gown during the study.
How the Test Will Feel
Some people may have discomfort from lying on the hard table.
Contrast given through an IV may cause a slight burning sensation, a metallic taste in the mouth, and a warm flushing of the body. These sensations are normal and usually go away within a few seconds.
Why the Test is Performed
CT rapidly creates more detailed pictures of the knee than can be seen on standard x-rays. The test may be used to:
- Diagnose or evaluate cancer or tumors
- Evaluate a mass that can be felt during a physical exam
- Evaluate an abscess or infection
- Evaluate pain or other problems in the knee joint when MRI cannot be done
- Guide a surgeon to the right area during a biopsy
- Identify masses and tumors, including cancer
- Identify or evaluate a fracture
Normal Results
Results are considered normal if the knee being examined is normal in appearance.
What Abnormal Results Mean
Abnormal results may be due to:
- Abscess
- Arthritis
- Fracture
- Tumor
Risks
CT scans and other x-rays are strictly monitored and controlled to make sure they use the least amount of radiation. CT scans do create low levels of ionizing radiation, which has the potential to cause cancer and other defects. However, the risk associated with any individual scan is small. The risk increases as numerous additional studies are performed.
In some cases, a CT scan may still be done if the benefits greatly outweigh the risks. For example, it can be more risky not to have the exam, especially if your health care provider thinks you might have cancer.
The most common type of contrast given into a vein contains iodine. If a person with an iodine allergy is given this type of contrast, nausea or vomiting, sneezing, itching, or hives may occur. Let your doctor know if you have ever had an allergic reaction to injected contrast dye.
If you absolutely must be given such contrast, your doctor may choose to treat you with antihistamines (such as Benadryl) or steroids before the test.
The kidneys help filter the iodine out of the body. Therefore, those with kidney disease or diabetes should receive plenty of fluids after the test, and be closely monitored for kidney problems. If you have diabetes or are on kidney dialysis, talk to your health care provider before the test about your risks.
Before receving the contrast, tell your health care provider if you take the diabetes medication metformin (Glucophage) because you may need to take extra precautions.
Rarely, the dye may cause a life-threatening allergic response called anaphylaxis. If you have any trouble breathing during the test, you should notify the scanner operator immediately. Scanners come with an intercom and speakers, so the operator can hear you at all times.
Alternative Names
CAT scan - knee; Computed axial tomography scan - knee; Computed tomography scan - knee
References
Beynnon BD, Johnson RJ, Coughlin KM. Knee. In: DeLee JC, Drez Jr. D. DeLee & Drez’s Orthopaedic Sports Medicine. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2003:chap 28.
Update Date: 2/4/2009
Updated by: Benjamin Taragin, MD, Department of Radiology, Montefiore Medical Center, Bronx, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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MEDICAL- INTERMITTENT CLAUDICATION - PAIN IN THE LEG
Updated: 22 Jun 2011
Patient Information - Intermittent Claudication
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1. What is Intermittent Claudication?
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| Claudication is the name given to pain in the leg caused by "furred up" or blocked arteries. If you have claudication, you can walk a little and then you get pain in either the calf, thigh or buttock. For some people the pain can be in all of these areas. The pain is usually like bad cramp and most people have to stop walking. After a few minutes the pain goes away and you can usually walk for the same distance or amount of time before the pain comes on again. |
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2. What causes the pain?
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| When we walk, our leg muscles need oxygen and other nutrients to work. If you have claudication, the main arteries to the leg (like motorways) are narrowed (only one lane rather than 3) or blocked (motorway closed). Like cars the blood can pass through the narrowed areas if the muscles do not need much oxygen. If the artery is blocked then like cars, the blood passes along other arteries called collateral vessels (Like A and B roads). If the muscles need more oxygen when you walk, the blood cannot get through fast enough (like holiday traffic) so the muscle has to work a different way (anaerobic respiration). The by-product of anaerobic respiration is lactic acid. It is this acid that causes the muscle pain or cramps. When you stop walking, the blood "catches up" and washes out the acid so the pain goes away. When you walk again, the whole process repeats itself. |
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3. Does the blockage ever clear itself?
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| No, unfortunately not, but the situation can improve due to opening up of the smaller collateral arteries which carry blood around the block. It is a bit like the body turns A roads into dual carriage ways. Many people notice some improvement, as the collateral circulation opens up, within six to eight weeks of the onset of claudication. |
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4. What happens if I am referred to Mr Braithwaite?
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| Mr Braithwaite will usually see patients with claudication at a special "one-stop" clinic at Queen's Medical Centre, Nottingham. If not people will often be asked to attend the vascular laboratory for assessment.
When Mr Braithwaite sees you, he will ask some questions and then examine your legs. He may measure the blood pressure in your legs using a special ultrasound machine called a Doppler probe. You will then be asked to walk on a treadmill similar to those seen in gymnasiums. Depending on the result of this test, Mr Braithwaite may advise you to change some of your lifestyle. He may arrange a duplex ultrasound test to see where the blockage is in your arteries. In some cases he may arrange a magnetic resonance scan of you arteries. If so, you may have to wait for an appointment from the x-ray department at QMC. It is possible that Mr Braithwaite will discuss the need for an angioplasty.
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5. How can I help myself?
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There are several things you can do which may help. The most important is to stop smoking, take regular exercise and lose weight.
Smoking. If you are a smoker you must make a sincere and determined effort to give up completely. Tobacco is harmful on two counts. Firstly, it speeds up the hardening of the arteries, which is the basic cause of the trouble and secondly, cigarette smoke clamps down the small collateral vessels and reduces the amount of blood and oxygen to the muscles. The best way to give up is to choose a day when you are going to stop completely rather than trying to cut down gradually. If you do have trouble giving up please ask your doctor who can give you advice on nicotine gum and patches or put you in touch with a support group.
Diet. It is very important not to put on weight, because the more weight the legs have to carry around the more blood they will need. Your doctor or dietician will give you advice with regard to a weight reducing diet. If your blood cholesterol is high you will need a low fat diet and may also require cholesterol lowering drugs.
Exercise. There is good evidence that people who take regular exercise (walking at an easy pace until pain comes, on then stopping and continuing again when the pain disappears) develop a better collateral circulation. Try and make it a little further each day, and you will almost certainly find that the distance you can manage without pain slowly but steadily increases. |
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6. What about treatment?
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Most people with intermittent claudication do not require surgery but if your symptoms are very severe, or if they do not improve, further treatment may be necessary. An x-ray of the arteries (arteriogram) is usually performed first to see what can be done. Short blockages can be stretched open with a balloon (angioplasty) in the x-ray department. This is usually done under local anaesthetic and often involves an overnight stay in hospital.
Longer blockages are bypassed using a plastic tube or vein from the leg (bypass graft). This is a major operation under general anaesthetic and involves being in hospital for about a week to ten days.
The decision about surgery is usually one for you to make yourself after your specialist has explained the likelihood of success and the risks involved. More detailed information about these procedures is also available - please ask Mr Braithwaite. |
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7. Do drugs help?
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| Although there are quite a number of proprietary tablets and drugs on the market there is very little evidence that they actually help - drugs will not unblock the artery. Perhaps your doctor has already tried one of these drugs in your case, so that you can judge for yourself. Aspirin is commonly prescribed because it makes the blood less sticky. A new drug called Plavix may help. |
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8. What is the risk of losing my leg?
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| Very few patients with intermittent claudication end up with an amputation and Mr Braithwaite will make every effort to avoid it. The most important thing is that you improve your lifestyle - keep walking, lose weight, take aspirin and stop smoking! |
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MEDICAL- GLOBAL WAR ON DRUGS -"A FAILURE" - LEADS TO A CALL TO LEGALISE CANNABIS AND OTHER DRUGS
Updated: 03 Jun 2011
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High-level panel declares international anti-drug measures a failure and suggests legalising cannabis and other drugs.
Last Modified: 02 Jun 2011 15:27
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| The commission recommends that certain drugs, including cannabis, be legalised [GALLO/GETTY] |
A high-level international commission has declared the global "war on drugs" to be a failure, and has urged countries to consider legalising certain drugs, including cannabis, in a bid to undermine organised crime.
The Global Commission on Drug Policy, in its report released on Thursday, called for a new approach to the current strategy of reducing drug abuse by strictly criminalising drugs and incarcerating users.
It said the new approach should focus on battling the criminal cartels that control the drug trade, rather than targeting drug users.
"The global war on drugs has failed, with devastating consequences for individuals and societies around the world," the report said.
The study urged "experimentation by governments with models of legal regulation of drugs", adding: "This recommendation applies especially to cannabis, but we also encourage other experiments in decriminalisation and legal regulation."
Illegal drug use
About 250 million people worldwide use drugs that are currently deemed illegal, with less than a tenth of them classified as "dependent". Millions are also involved in the cultivation, production and distribution of drugs, according to the United Nations estimates quoted in the report.
The study said decriminalisation initiatives have not been accompanied by a significant spike in drug use, citing the implementation of such policies in Australia, Portugal and the Netherlands.
"Now is the time to break the taboo on discussion of all drug policy options, including alternatives to drug prohibition," Cesar Gaviria, the former Colombian president, said.
The commission called for the urgent implementation of fundamental reforms in national and international drug control policies.
In particular, it recommended that the focus of drug control policies be moved from users as well as "farmers, couriers and petty sellers", and onto the large criminal organisations involved in the drug trade.
It called on governments to "end the criminalisation, marginalisation and stigmatisation of people who use drugs but who do no harm to others".
"Arresting and incarcerating tens of millions of these people in recent decades has filled prisons and destroyed lives and families without reducing the availability of illicit drugs or the power of criminal organisations," the report said.
Treatment services recommended
It said that drug users who need health and treatment services should be offered them.
"Let's start by treating drug addiction as a health issue, reducing drug demand through proven educational initiatives and legally regulating rather than criminalising cannabis," Fernando Cardoso, the former Brazilian president, said.
The changed approach would focus law enforcement resources more against violent organised crime and drug traffickers, while providing alternative sentences for small-scale or first-time drug dealers.
The report said "vast expenditure" had been spent on criminalisation and repressive measures.
"Repressive efforts directed at consumers impede public health measures to reduce HIV/AIDS, overdose fatalities and other harmful consequences of drug use," it said.
The 19-member panel includes current Greek prime minister George Papandreou, former UN secretary-general Kofi Annan, British businessman Richard Branson and former US secretary of state George Shultz.
Other members include former Mexican president Ernesto Zedillo, former Swiss president Ruth Dreifuss, former EU foreign policy chief Javier Solana and former US Federal Reserve chief Paul Volcker.
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MEDICAL- A DOCTOR PLAYING GOD ?
Updated: 23 May 2011
GP rapped for talking about God with patient
A family doctor, Dr Richard Scott, fears losing his job after he was reprimanded by the General Medical Council for talking to a patient about God.
By Jonathan Wynne-Jones, Religious Affairs Correspondent 9:00PM BST 21 May 2011
The committed Christian, was accused of “harassment” and told by the medical regulator that he risked bringing the profession into disrepute by discussing his religious beliefs.
The Cambridge-educated doctor has refused to accept a formal warning on his record, and is instead taking legal action to fight the censure.
His case follows a series of high-profile disputes between Christians and their employers over their freedom to express their beliefs, including an electrician who displayed a cross in his van and a nurse who prayed for a patient.
Dr Scott, 50, a married father of three, saw the patient who is at centre of the complaint in 2010.
Following the consultation, the patient’s mother complained that the doctor had abused his position by “pushing religion” on her son.
He argues that he acted within official guidelines, having asked if he could talk about his Christian beliefs to the patient, who is of a different faith, and having ended the conversation as soon as he was asked to.
The conversation only turned to religious matters after they had fully explored the medical options, according to Dr Scott.
“He viewed his problem as purely medical issue and I said it might be more than that,” he said.
“It was a consensual discussion between two adults.”
After receiving the complaint, the GMC told Dr Scott that it was taking the matter seriously, and last month it sent a letter warning him over his conduct.
The regulator told the doctor that the way he expressed his religious beliefs had “distressed” the patient and did “not meet with the standards required of a doctor”.
Dr Scott, a doctor for 28 years, works at the Bethesda Medical Centre in Margate, Kent.
Its six partners are all Christians and state on the official NHS Choices website that they are likely to discuss spiritual matters with patients during consultations.
Dr Scott, who worships at St Paul’s Cliftonville, an Anglican church, said he has shared his faith with thousands of patients in the past because he believes that there is a spiritual element to healing.
He had had “a handful of complaints” in the past, but they had all been resolved locally and none had escalated into matters for the regulator.
He is so determined to clear his name that he is preparing to take the case to an appeal even though he has been warned this could result in him being struck off.
“What’s happened to me is an injustice and I want to stand up for Christians who have been getting hammered in the workplace,” he said.
The Christian Legal Centre, which seeks to promote religious freedom, is handling Dr Scott’s case and has instructed Paul Diamond, the leading human rights lawyer.
Andrea Williams, the founder and director of the centre, called on the GMC to back the GP and not to bow to “political or emotional pressure”.
“He acted within their own guidelines, and his unblemished record should not be tarnished – even by a letter on his file,” she said.
Niall Dickson, chief executive of the GMC, said: “Our guidance, which all doctors must follow, is clear.
Doctors should not normally discuss their personal beliefs with patients unless those beliefs are directly relevant to the patient’s care.
"They also must not impose their beliefs on patients, or cause distress by the inappropriate or insensitive expression of religious, political or other beliefs or views.” |
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MEDICAL- TAKING SUGAR WITH ANTIBIOTICS CAN IMPROVE THEIR EFFECTIVENESS
Updated: 23 May 2011
James Collins: A spoonful of sugar helps the medicine go down
Bioengineer James Collins has discovered that taking antibiotics with sugar may increase their power to tackle persistent infections
Ian Tucker
James Collins: 'Unfortunately, resistance happens everywhere.
Basically it's their genomes against our wits.'
James Collins is a professor of biomedical engineering at Boston University and a Howard Hughes Medical Institute investigator.
A former Rhodes Scholar, he has been the recipient of many scientific honours including, in 2003, becoming the first bioengineer to receive a MacArthur Foundation "genius award".
He recently published a paper that showed how taking antibiotics with certain sugars could improve their effectiveness against stubborn infections.
Stubborn infections are caused by "persisters". Could you explain what these are?
Genetically, they aren't different from the bacteria that make you ill.
They are part of the population of infectious bacteria but they go into hiding or hibernation, which affords them protection against certain stresses, including antibiotics.
The persisters are a bet-hedging strategy by the population – they'll be the ones that will survive in case of attack. There may be one in 1,000 or 10,000 in the population.
It's like when the US president gives his State of the Union address and one member of his cabinet stays away in hiding, so that if disaster strikes the government will continue.
As a patient, how do I know if I have a stubborn infection, a new infection or an infection that is resistant to antibiotics?
You know you've got a resistant infection if you're not getting better.
Typically, a persistent infection would be one where you take your two-week course, you're fine, you go about your business and two weeks later you're sick again. In the past, we thought this happened because you were in a weakened state and you had contracted a related bacterial infection.
But now the thinking is that it's the same infection – that the antibiotics were not effective in killing off all of the persisters.
Typically, the antibiotics won't get them all, but your immune system will kill off the persisters.
But this final stage may not happen if you are in a weakened state due to tiredness or stress, which compromises your immune system.
So why did you target the persisters with sugar?
We've been interested in persisters for a few years.
We wanted to understand how a population would switch off or on certain processes to allow a tiny fraction of its population to enter this quasi-dormant state.
We're bioengineers so we also decided to figure out a way we could kill them.
Initially, we thought we could deliver sugars to wake them up, so the antibiotics would be able to kill them.
And this strategy was successful?
A single class of antibiotics – aminoglycosides – were in fact killing off the persisters in the presence of certain sugars. This then led us to figure out what the sugars were actually doing to cause the effect.
Our analysis revealed that these resisters aren't completely dormant, that some aspects of the metabolism are primed and ready to go and just need a little kick, from the sugar.
The sugar can enter some aspects of the metabolism and trigger certain processes that would allow these cells to take up aminoglycosides and thereby seal their fate, allowing the drugs do their thing and kill them off.
You could simply use sugar?coated pills?
Possibly, yes. I was contacted by a company that specialises in sugar-coating pills.
Drug companies have shown interest in my research. It's such a simple and inexpensive solution, I'm hopeful that it could be used around the world, including in areas such as Africa, where there are not many resources but many infectious diseases.
Are you talking about the kind of sugars I could buy in a supermarket?
We've done studies with mice where we used a sugar alcohol called mannitol, which isn't well metabolised by the human body so holds promise that it could be used as an effective therapy.
You can acquire mannitol easily; I think it's used in chewing gum as a flavouring.
Don't tell me you had this idea while watching Mary Poppins…
No I didn't, but I'm a fan of the movie, and we've shown it to our kids.
You have hopes you could apply this idea to other infections?
In the first study, we demonstrated the effect on E coli – associated with urinary tract infections – and staphylococcus, which is mainly skin-related. Next we are looking to see if similar methodologies could be applied to TB infections.
TB is a worldwide problem and one for which persistent infections are highly significant.
I suspect there are other conditions, including pneumonia, for which this approach has potential.
The general thinking is that persisters are a common strategy used by all kinds of bacterial populations.
Could this help in the race against drug?resistant bacteria?
Unfortunately, resistance happens everywhere.
Basically, it's their genomes against our wits.
Eventually, they develop resistance to whatever we throw at them. In the case of TB, there's growing concern about multi-drug resistant TB.
However, dead bacteria don't mutate. |
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MEDICAL- IS THE URGE TO RAPE A MENTAL ILLNESS ?
Updated: 21 May 2011
Debate over medicalisation of the urge to rape
Should a propensity to commit rape be considered a mental illness?
Debate has been raging, and now it seems that "paraphilic coercive disorder " will not make its debut in the next edition of psychiatry's diagnostic handbook.
In February 2010, PCD was proposed for inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), scheduled for publication in 2013.
An expert group convened by the American Psychiatric Association (APA) argued that PCD was distinct from sexual sadism, and applied to men who experienced intense fantasies or urges involving sexual coercion over a period of at least six months, if this caused them significant distress or impairment or had led them to force sex on "three or more non-consenting persons on separate occasions".
Sexual predators
Critics disputed evidence that PCD is a distinct mental disorder. It's a "wastebasket category", argues psychologist Raymond Knight at Brandeis University in Waltham, Massachusetts. The debate became highly charged, because many US states have laws that allow sex offenders who have served prison sentences to be detained indefinitely in a secure hospital if they are deemed dangerous "sexual predators".
A ruling from the US Supreme Court states that this can be done only if they have a mental disorder that makes them likely to commit further sexually violent acts. At present, many of those held under these laws have a vague diagnosis of "paraphilia (not otherwise specified)", which is coming under legal challenge.
The DSM-5 website now says PCD is being considered for inclusion in the manual's appendix, rather than as a new diagnosis – a designation intended for conditions that need more research.
Kenneth Zucker of the University of Toronto in Canada, who heads the DSM-5 work group on sexual disorders, hopes that more data on the validity of PCD will be available in the next few months. But that would not leave sufficient time to digest the results before the final deadline for proposed new diagnostic criteria, he explains. "We therefore thought that the most conservative approach was to consider PCD only for the DSM-5 appendix."
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MEDICAL- MORE ON MALE MENOPAUSE
Updated: 18 May 2011
The Condition And More Male Menopause Symptoms
The condition and the symptoms of male menopause are comparable to the women of the experience and at times it may be worse.
However, male menopause does not affect all men, at least not with the inclusion of the same.
Some of the men between the 1940s and 1950s can only experience the condition and the majority of the male menopause symptoms.
All the changes that occur in each man during the male menopause can affect all aspects of their lives.
Male menopause is recognized as a physical condition and manifest in personal, psychological, social and spiritual dimensions.
Men also have difficulties to hormonal fluctuations that affect their sexuality, humor and personality as a woman.
It is only one of the manifestations of the ageing process of a man, where changes come and that the best person out of it.
All the men passing by male menopause may experience hormonal changes that dramatically affect their lives.
Hormone levels fall in his Mid-Life and may have changes that are usually associated with the male menopause.
It is important that each man has a unique personality and their individual levels of hormone loss vary widely.
They have different perspectives on life and living with satisfaction strategies.
If you decrease the level of hormones, it can be the cause of the decreased libido and general health.
The appearance of these things will also enable the increase of depression and weight gain and absolutely change the life of every day, in comparison with their lives before the onset of male menopause.
During menopause, some men may experience problems with impotence.
Where is the constant inability to achieve and maintain an erection that is sufficient for satisfactory sexual performance.
And due to impotence, have men lowered sexual desires.
How can recognize a man who is going through some stage in life, the period of menopause?
There are some symptoms to be taken into account.
Some are physical, some are psychological, and some are sexual.
The following are symptoms that a man is going through a period of menopause male.
Male menopause symptoms include:
• Recovery of injuries and illness takes longer
• Less resistance to physical activity
• Weight gain
• Difficulty reading small print
• Loss or thinning of hair
• Sleep disorders
• Low libido
• Lack of energy
Psychological male menopause symptoms include:
• Irritability
• Hesitation or difficulty in making decisions
• Worry and fear for the life
• Depression
• Have joy, confidence, and low self-esteem
• Loss of purpose and direction in life
• You feel alone, attractive and
• Lack of memory and the complexity in the concentration
• Mood
Sexual male menopause symptoms include:
• Decreased libido
• Fear of sexual impotence
• More problems of relationship and fighting occurs with regard to sex, love and intimacy
• Inability to erect for privacy
• Increase of attraction to a much lower against sex
They can treat all the symptoms that a man can experience during the male menopause.
Although the men suffer physical symptoms, emotional or sexual male menopause, needs control not through deal with self-diagnostic but by talking to a doctor, this will lead to be better informed and receive the appropriate treatment to relieve symptoms of the disease.
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MEDICAL- WHEN WILL DR'S TAKE MALE MENOPAUSE SERIOUSLY ?
Updated: 18 May 2011
Male Menopause
Have you noticed your father, brother, or partner acting strangely lately?
Does he forget things, seem lethargic, or wake up sweating?
If so, he may be suffering from male menopause. While this likely sounds unbelievable to most women, more and more people are suggesting that male menopause really does exist.
Like female menopause, menopause in men seems to involve a drop in hormone levels around middle age.
Often referred to with contempt as the "mid-life crisis," men may really be suffering from a documented illness.
So grab the man in your life and make him aware of what he may be facing when he reaches middle age.
What is Male Menopause?
Male menopause, also called andropause, refers to a gradual decline in a man's testosterone levels. Not all men will go through andropause and it is unknown why those that will, do.
Testosterone is the male sex hormone that is responsible for creating and releasing sperm, initiating sex drive and providing muscular strength.
Hormone levels tend to peak around the ages of 15 to 18 in most males.
Sometime during his mid to late 20s, a man's hormone levels will begin to drop slowly.
Usually, these hormone levels will remain at a healthy level, but some men will see their testosterone levels drop significantly by the time they are 40.
By age 50, half of all men will experience a significant reduction in testosterone levels, causing a variety of uncomfortable ailments.
Causes of Male Menopause
Male menopause can occur naturally in some men.
More often than not, though, andropause is triggered by illness, depression, dementia, and obesity.
Certain diseases that attack the heart and lungs also seem to affect the production of testosterone.
Men who have had autoimmune diseases or cancer seem to be at an increased risk for low testosterone levels.
Andropause vs. Menopause
Menopause in men is not entirely similar to female menopause.
Female menopause involves the complete decline of sex hormones.
During menopause, your estrogen levels will decrease and then disappear, causing acute symptoms and the complete loss of fertility.
Men will never lose their fertility completely during andropause.
Testosterone will continue to be produced, as will sperm, permitting a man to have children well into his 80s.
For this reason, there is much debate over whether this testosterone drop should be referred to as the male "menopause."
What are the Symptoms of Male Menopause?
Male menopause symptoms are very similar to those experienced by women during menopause, only much less intense.
Common menopause symptoms include hot flashes, night sweats, fatigue, muscle and joint aches.
Men also suffer from emotional symptoms like mood swings, irritability, depression, and listlessness.
Sex and menopause in men is also an issue of concern.
The most common symptom experienced by men with low testosterone is a diminished sex drive. 80% of men with documented andropause complain of low libido and an inability to maintain a strong erection.
Like women going through menopause, men can begin to feel like they no longer enjoy sex.
If this is the case, a visit to the doctor can really help men to feel more in control of their physical and sexual wellbeing.
Treatment Options
Men often do not seek treatment for andropause.
A lot of men feel uncomfortable speaking about their symptoms and, in the past, doctors haven't taken men's menopause seriously.
Signs of menopause in men can also be difficult to diagnose.
Thanks to new studies, though, doctors have become more aware of this problem and are beginning to realize the importance of treatment.
The primary treatment for andropause is Testosterone Replacement Therapy (TRT). Like estrogen replacement in women, testosterone replacement aims to bring hormonal levels back up to a healthy level.
Once testosterone levels are increased, most men begin to experience fewer symptoms. Unfortunately, testosterone replacement doesn't always work well to combat erectile dysfunction.
Because this is such a severe symptom for most men, other treatments for erectile dysfunction should be investigated.
It is important for men to understand what is happening to their bodies as they age. Andropause does not affect all men and its symptoms have varying degrees of severity.
However, if you know someone who is affected by andropause, encourage him to talk about his symptoms with a doctor. |
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MEDICAL- HEART ATTACKS ARE MORE DANGEROUS IN THE MORNING
Updated: 14 May 2011
Heart attacks are more dangerous in the morning
A HEART attack in the morning causes more damage than an attack at any other time of the day.
Borja Ibanez and colleagues at the Carlos III University of Madrid in Spain collected details from 811 people who suffered a heart attack between 2003 and 2008. The team recorded when symptoms started and blood levels of two protein markers for heart damage.
The proteins are enzymes that normally stay inside heart cells, but are released when cells die. Rising enzyme levels in the blood mean a lot of tissue has died.
Heart damage was significantly greater following morning attacks (Heart, DOI: 10.1136/hrt.2010.212621). "There's a peak between 6 am and noon," says Ibanez. "People who had heart attacks during this period had 20 per cent more tissue death compared with those who had attacks at any other time."
Ibanez reckons protective proteins called salvage kinases may be responsible. Heart cells in rodents and pigs release varying amounts throughout the day with less produced in the morning. "Proteins that protect human heart cells from damage could provide new therapies," he says. |
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MEDICAL - DEAFNESS
Updated: 13 May 2011
Hearing impairment, or deafness, is when your hearing is affected by a disease, disorder or injury.
The structure of the ear
The ear consists of three parts:
- the outer ear
- the middle ear
- the inner ear
The outer ear
The outer ear is made up of a number of parts, including:
- the visible part of the ear on the side of your head (the pinna)
- the ear canals that go into your head
- the eardrum – a thin layer of tissue that separates the outer ear from the middle ear.
The middle ear
The middle ear is located directly behind the eardrum. It is made up of three tiny bones called ossicles, which are also known as the:
- stapes – a stirrup-shaped bone that transmits sound vibrations from the incus to the inner ear
- incus – an anvil-shaped bone that transmits sound vibrations from the malleus to the stapes
- malleus – a hammer-shaped bone that transmits sound vibrations from the eardrum to the incus.
The inner ear
The inner ear is made up of the:
- cochlea – a coiled, spiral tube that contains two fluid-filled chambers
- auditory nerve – the nerve that transmits sounds to the brain.
How does hearing work?
Sound waves enter your ear and make your eardrum vibrate. The vibrations pass on to the three small bones (the ossicles) inside your middle ear. The ossicles amplify (intensify) the vibrations and pass them on to your inner ear.
The cochlea, inside your inner ear, contains many tiny hair cells, which move in response to the vibrations passed from the middle ear. The movement of the hair cells generates an electrical signal that is transmitted to your brain through the auditory nerve.
Types of hearing loss
There are two main types of hearing loss:
- conductive hearing loss – sounds are unable to pass from your outer ear to your inner ear, often as the result of a blockage, such as earwax or a build-up of fluid
- sensorineural hearing loss – the sensitive hair cells inside the cochlea, or the auditory nerve, are damaged, either naturally through ageing, or as the result of an injury.
Sometimes, both types of hearing loss may occur at the same time. This is known as mixed hearing loss. See the Hearing impairment - causes section for more about conductive and sensorineural hearing loss.
Facts
In the UK, hearing impairment is a common condition. The Royal National Institute for Deaf People (RNID) estimates that in the UK almost 9 million people are hearing-impaired.
Approximately 28% of people who are hearing impaired are between 16-60 years old, and 72% are over 60 years old.
In terms of age-related hearing loss, about 71% of people who are hearing impaired are over 70 years old. The severity of hearing impairment among this age group is as follows:
- mild – 38%,
- moderate – 52%
- severe – 10%
Approximately 42% of people who are over 50 years old have some kind of hearing impairment. The severity of hearing impairment among this age group is as follows:
- mild – 52%,
- moderate – 41%
- severe – 7%
Each year in the UK, around 840 babies are born with a significant hearing impairment. About 1 in 1,000 children are deaf at age three.
Approximately 20,000 children between 0-15 years old are moderately to severely deaf. About 12,000 children within this age range were born deaf.
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MEDICAL- OSTEO-ARTHRITIS
Updated: 13 May 2011
Osteoarthritis is a condition that affects the joints. It is the most common type of arthritis in the UK. Around 1 million people see their GP about it and the NHS in England and Wales performs over 140,000 hip and knee replacement operations every year.
Three key characteristics of osteoarthritis are:
- mild inflammation of the tissues in and around the joints
- damage to cartilage, the strong, smooth surface that lines the bones and allows joints to move easily and without friction
- bony growths that develop around the edge of the joints
Osteoarthritis mostly occurs in the knees, hips and small joints of the hands and base of the big toe. However, almost any joint can be affected.
Who develops osteoarthritis?
Osteoarthritis usually develops in people over 50 years of age and is more common in women than in men. It is commonly thought that osteoarthritis is an inevitable part of getting older, but this is not quite true. While in very old people the changes of osteoarthritis are visible on X-rays, they don’t always have related pain or problems with joint function.
Younger people can also be affected by osteoarthritis, often as a result of an injury or another joint condition.
Managing osteoarthritis
The symptoms of osteoarthritis vary greatly from person to person, and between different affected joints.
The amount of damage to the joints and the severity of symptoms can also vary. For example, a joint may be severely damaged without causing symptoms, or symptoms may be severe without affecting the movement of a joint.
There is no cure for osteoarthritis, but the symptoms can be eased with a number of different treatments. Mild symptoms can often be managed with exercise or by wearing suitable footwear. However, in more advanced cases of osteoarthritis, other treatments may be necessary.
Treatments include non-drug treatments, including physiotherapy and weight loss, medications such as painkillers, and surgery.
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