BMA Comment On Health Bill – Concern About Personal Care Budgets, But Tobacco Control Measures Good News, UK
The BMA says it is pleased to see tobacco control measures, and steps to enhance the quality of patient care, proposed in friday’s (16 January, 2009) Health Bill. However, it has concerns about other proposals, such as personal care budgets for NHS patients.
Dr Hamish Meldrum, Chairman of Council at the BMA, says:
“The public deserves a high quality, integrated, innovative NHS which focuses on their needs, and is clinically led in partnership with patients. Political ideology must not get in the way of this goal.
“While many aspects of this bill are positive, there are significant concerns. We await the outcome of the pilot of direct payments, but believe they may not be the best way of giving patients more power. It is currently very unclear how such a system would work in practice, for example what would happen when a patient’s budget ran out. Moreover, this policy seems to further establish the idea of healthcare as a commodity, which the BMA does not believe is in patients’ best interests.”
On proposals to protect young people and children from the harm caused by smoking, Dr Meldrum says: “The BMA is very pleased that the Government is planning to introduce measures to protect children and young people from tobacco. Half of smokers will die because of their habit, so it is essential that children and young people don’t start smoking. Some young people mistakenly believe smoking to be cool and glamorous but the truth is that it kills and destroys lives.”
On proposals to encourage innovation and improve quality in the NHS, he adds:
“Doctors are at the forefront of innovation in the NHS. We welcome the government’s commitment to continued improvements to the quality of services to patients.”
http://www.bma.org.uk
New Blood Glucose Target Ranges, UK
Diabetes UK has updated its blood glucose target ranges for people with diabetes, following recommendations from the National Institute for Clinical Excellence (NICE).
In November 2007, the International Diabetes Federation (IDF) suggested changes to the post-meal target ranges.
In 2008, NICE published their guidelines for Type 2 diabetes, again with changes to the target ranges.
As part of Diabetes UK’s policy to continually review and update advice for people with diabetes, we have now reviewed our recommendations in line with NICE.
Details of our new recommendations can be found by following the related links on this page.
Diabetes UK
How Aging Undermines Bone Healing
Goal: Make the old heal like the young
Researchers have unraveled crucial details of how aging causes broken bones to heal slowly, or not at all, according to study results published in the Journal of Bone and Mineral Research. The research team also successfully conducted preclinical tests on a potential new class of treatments designed to “rescue” healing capability lost to aging.
In the worst cases, an age-related delay in healing keeps the two sides of a fractured bone from ever rejoining (non-union), leaving many confined to wheelchairs, unable to walk or to live independently. Of the estimated 5.6 million fractures in the United States each year, between five and ten percent (up to 560,000) will heal slowly or incompletely. Researchers have known for 30 years that aging interferes with fracture healing, and have been filling in the details since on the complex web of biochemicals, stem cells and genes that bring about healing. The field is now reaching the point where precision designed drugs are in different stages of animal and human trials.
The current study is focused on cyclooxygenase 2 (COX-2), an enzyme known from past studies to drive stem cells to differentiate into cartilage, which then matures into bone. Researchers at the University of Rochester Medical Center 20 years ago discovered the gene in humans that is responsible for producing the COX-2 enzyme and revealed the enzyme’s role in causing inflammation, the reason drugs like the painkiller Vioxx were developed to shut down its action. Then about seven years ago another research team here determined that COX-2 also plays an essential role in bone formation during skeletal repair.
The current study shows for the first time that COX-2 levels drop dramatically with age, and that the drop most explains why stem cells no longer turn into cartilage as efficiently, an early step in the chain reaction of healing. While a role for COX-2 in bone repair had been detailed prior to the current study, the cell populations responsible for the supply of COX-2 to the fracture callus, the layer of pre-cartilage cells (cartilage progenitors) that form first around a fracture to guide bone building, had not. The team also confirmed for the first time that healing ability lost with age can be rescued by manipulating the COX-2 pathway with existing, experimental drugs. The study was in mice, but is especially relevant to human medicine because of the similarity between human and mouse COX-2 gene, and because the study mice were engineered by the National Institute on Aging, and have inspired several major insights into aging that have been validated in humans.
“The skeleton loses the ability to repair itself as we age,” said Regis J. O’Keefe, M.D., Ph.D., chairman of the Department of Orthopaedics at the University of Rochester Medical Center and corresponding author of the article. “Our results position the COX-2 pathway as one of several under exploration with the common goal of accelerating healing in aging humans, and with the potential to come together in future combination therapies.”
Turning Back the Clock
In the current study, healing rates were compared between a group of young mice (7-9 weeks old) and a group of old mice (52-56 weeks of age), with healing evaluated by imaging and gene expression studies. Specifically, the current study found that the older mice experienced delayed fracture healing, decreased bone formation and decreased resupply of blood vessels to the healing site in aging mice. Expression of the gene that codes for production of the COX-2 was reduced by 75 percent in fractures between aged mice and young mice during the early healing phase five days after a fracture. COX-2 expression in young mice peaked at the exact time that stem cells were changing into cartilage within the fracture callus of young mice, and was reduced during that period in older mice.
In addition, experiments confirmed that COX-2 is expressed primarily in early stem cell precursors of cartilage that also express collagen, type II, alpha 1 (col2a1), the gene that codes for production of a key part of type II collagen in mice and humans, the fibrous, structural protein that lends strength to bone. Researchers observed in aged mice a dramatic decrease as well in the expression of other genes known to contribute to bone formation as well (e.g. osteocalcin and type X collagen). Altogether the results suggest that in aging animals gene expression is altered early in fracture repair with consequences for the entire healing cascade.
Researchers found further proof that COX-2 is responsible for loss of bone healing ability with age when they were able to reverse the process with a drug known to encourage the COX-2 signaling effect. COX-2 catalyzes the conversion of a fatty acid to prostaglandin E2 (PGE2), a hormone with many functions in the animal body depending on the type of cell they interact with, from blood vessel dilation to embryo implantation in the womb to bone healing. PGE2 is known to have it effect on cells by reacting with one of four receptor proteins (EP1-EP4) on the surface of cells, including the surfaces of bone marrow stem cells, cartilage cells and bone-producing cells (osteoblasts). Human cells send and receive signals that switch on life processes through workhorse proteins called receptors that enable messages to penetrate cells.
Prior work in other labs had established that the ability of PGE2 to create new bone growth occurs in particular through its interaction with the EP4 receptor. In the current study, the team showed that delayed fracture healing observed in aged mice could be rescued with local delivery of an experimental drug, CP-734432, which directly activates the EP4 receptor in place of the missing COX-2 (an EP4 agonist). The drug, provided to the team by Pfizer Inc., was also recently used to prevent osteoporosis in early animal studies. Local injection of an EP4 agonist to the fracture site of aged mice compensated for the reduced fracture repair observed with aging, with a significant reduction in immature cartilage seen and more efficient formation of mature bone.
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Article adapted by Medical News Today from original press release.
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Along with O’Keefe, the study effort was led by Amish Naik, Chao Xie, Michael Zuscik, Edward Schwarz, Hani Awad, J. Edward Puzas, Brendan Boyce and Xinping Zhang within the Center for Musculoskeletal Research, as well as by Paul Kingsley within the Department of Pediatrics, at the Medical Center. Major contributions were also made by Hichim Drissi within the Department of Orthopaedics at the University of Connecticut School of Medicine and Robert Guldberg from the Institute for Bioengineering and Bioscience at Georgia Institute of Technology. The study was funded by Public Health Service and the Howard Hughes Medical Institute.
Source: Greg Williams
University of Rochester Medical Center
For Children With Pyloric Stenosis, Laparoscopic Technique Has Advantages Over Open Surgery
The use of small, laparoscopic equipment to correct pyloric stenosis in newborn children has advantages over open surgery – but the laparoscopic technique should only be performed in centres with the required level of expertise. These are the conclusions of an Article published Online First and in an upcoming edition of The Lancet, written by Dr Nigel Hall and Professor Agostino Pierro,Department of Paediatric Surgery, Institute of Child Health, University College London, UK and Great Ormond Street Children’s Hospital, London, UK, and colleagues.
Pyloric stenosis is a condition that causes severe vomiting in the first few months of life. There is narrowing (stenosis) of the opening from the stomach to the intestines, due to enlargement (hypertrophy) of the muscle surrounding this opening (the pylorus, meaning “gate”), which spasms when the stomach empties. Pyloromyotomy is a surgical procedure in which an incision is made in the longitudinal and circular muscles of the pylorus, to correct this spasming. Open pyloromyotomy has been available since the early 20th century. But in the 1990s, laparoscopic equipment was developed to allow enable much less invasive access in the abdomens of infants. The researchers did a randomised controlled trial to compare the two techniques – open (OP) and laparoscopic pyloromyotomy (LP) – for the treatment of pyloric stenosis.
This international study* looked at 190 children from six children’s surgery units, of which 93 were assigned to OP and 87 to LP. The primary outcomes of the study were the time to achieve full normal feeding and the duration of post-operative recovery. The study was double blinded – parents and doctors did not know which treatment was being received, and the children were bandaged post-operation so that it was still impossible to determine which type of operation they had undergone.
The researchers found that time to full normal feeding was lower in LP group (18.5 hours) versus the OP group (23.9 hours). Post-operative recovery time was also shorter in the LP group (33.6 hours) compared with the OP group (43.8 hours). Postoperative vomiting, and intra-operative and postoperative complications were similar between the two groups. The authors conclude: “In view of these results, we feel that most surgeons and parents would choose laparoscopy. Furthermore, the difference of more than 10 h in postoperative length of stay might mean an extra day in hospital after open pyloromyotomy, with logistical and cost implications… We think that our findings justify the continued use of laparoscopic pyloromyotomy for the treatment of pyloric stenosis, and recommend its use in centres with suitable laparoscopic experience.”
They add**: “This was the first large multi-centre double-blind randomised controlled trial which supports the use of laparoscopy (key hole surgery)in children. The trial was stopped early due to benefit in one treatment arm (laparoscopy) and as such is the first randomised controlled trial in the field of paediatric surgery to report such strong findings. The results of this study represent a significant advance for the role of laparoscopy in children and will have an impact on the provision of surgery for children in the future.”
In an accompanying Comment, Dr Aydin Yagmurlu, Department of Paediatric Surgery, Faculty of Medicine, Ankara University, Turkey, says: “Surgeons who prefer the open approach and those surgeons with the skill and necessary experience in the laparoscopic approach can take comfort in knowing that both techniques have been validated by Hall and colleagues’ findings… I do not recommend surgeons with limited experience to try to instruct laparoscopic pyloromyotomy to their residents or registrars until they reach an accumulated institutional experience.”
“Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial.”
Nigel J Hall, Maurizio Pacilli, Simon Eaton, Kim Reblock, Barbara A Gaines, Aimee Pastor, Jacob C Langer, Antti I Koivusalo, Mikko P Pakarinen, Lutz Stroedter, Stefan Beyerlein, Munther Haddad, Simon Clarke, Henri Ford, Agostino Pierro
Source
Tony Kirby
Press Officer
The Lancet
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http://www.thelancet.com
New Piece In The Jigsaw Puzzle Of Human Origins
In an article in Nature, Uppsala researcher Martin Brazeau describes the skull and jaws of a fish that lived about 410 million years ago. The study may give important clues to the origin of jawed vertebrates, and thus ultimately our own evolution.
Ptomacanthus anglicus was a very early jawed fish that lived in the Devonian period some 410 million years ago. It represents a type of fossil fish known as an “acanthodian” which is characterized by a somewhat shark-like appearance and sharp spines along the leading edges of all fins (except for the tail fin). This group of early jawed fishes may reveal a great deal about the origin of jawed vertebrates (a story that ultimately includes our own origins). However, their relationships to modern jawed vertebrates (and thus their evolutionary significance) are poorly understood, owing partly to the fact that we know very little about their internal head skeleton.
“To date, we have detailed data from one genus Acanthodes, which occurred very late in acanthodian history”, Martin Brazeau says.
I present details on the morphology of the braincase of Ptomacanthus, which is more than 100 million years older than Acanthodes. It is a radically different morphology from Acanthodes, which has several important implications for the relationships of acanthodians. The braincase of Acanthodes appears to most closely resemble that of early bony vertebrates, the lineage that ultimately includes humans and other land-living vertebrates). For this reason, the acanthodians were thought to share a closer ancestor with bony vertebrates than with sharks. However, the braincase of Ptomacanthus more closely resembles that of early shark-like fishes, and shares very few features in common with Acanthodes and the bony vertebrates.
“As a consequence, the results indicate that Ptomacanthus was either a very early relative of sharks, or close to the common ancestry of all modern jawed vertebrates”
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Article adapted by Medical News Today from original press release.
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Source: Martin Brazeau
Uppsala University
Biologist Enhances Use Of Bioinformatic Tools And Achieves Greater Precision In Genetic Annotation
José Luis Lavín Trueba, a graduate in biology and biochemistry from the University of Salamanca (Spain) and currently collaborator in the Genetic and Microbiology Research Group at the Public University of Navarre, has enhanced the use of bioinformatic tools for the identification and annotation of certain fungal and bacterial genes.
For his PhD thesis, “Strategies for the comparative genomic study of microorganisms with various levels of pregenomic information and genic complexity”, Dr Lavin used an emerging discipline: bioinformatics. By using informatics tools for studying sequences of DNA and proteins, he managed to generate databases for the genetic diversity of various organisms.
José Luis Lavín’s thesis has two differentiated parts which have in common the design of an enhanced technique of bioinformatic analysis that enables a greater degree of precision in the results. Thus, the first part of his work involved the study of bacteria, comparing genomes (the total set of genes in an organism) of pathogenic bacteria – the cause of illnesses – both animal and vegetable. Through the comparison of genic sequences, gene candidates responsible for the infection process are detected. As the researcher himself explains, “We used very similar bacteria and looked for differences between them. In one study, we took a plant pathogen (Pseudomonas syringae) that attacks a number of crops such as bean, soya, tomato; in another we used various genomes of the causal agent for brucellosis (the Brucella genus), given that each variety of this bacteria attacks one type of animal breed specifically. In each case what was common was recorded and we have annotated what differentiated them”. These results are available to other research teams specialising in the treatment of bacteria so that they can use these target genes and, through mutations or simply by deactivating them, it can be seen if, effectively, they are responsible for plagues and illnesses and, thereby, control these.
During his stay in Denmark, in 2006, José Luis Lavín learnt the use of a new bioinformatic tool (HMM software), which he now uses in his research. The novelty, he explains, lies in that all the trials were carried out by computer. He used existing techniques but in such a way that he achieved the aim sought with the least possible percentage of error. The procedure has been considerably refined, given that, until now, the different techniques that existed were used separately and in an order that was not the correct one. Having defined parameters and a manual of correct procedure, very good results were achieved and with a minimum margin of error.
Sequencing of fungal genes
The second part of José Luis Lavín Trueba’s PhD focused on certain fungal genes, known as OXPHOS genes. These, if presenting defects in the human species, may produce illnesses such as Alzheimer’s, Parkinson’s, muscular dystrophies, etc. There are currently 27 genomes of fungi that have been sequenced and, amongst of all these what has been done is to detect what the differences are in the genes of the OXPHOS route. They did something similar as in the first part of the research with bacteria: they used bioinformatic tools and optimised them in order to achieve the detection of OXPHOS genes in the different genomes of the fungi; they looked for a methodology that enabled them to identify these genes with the greatest possible precision. In fact, this methodology is the reference pattern for a number of international projects for the sequencing of fungi genomes in which the Public University of Navarre research team also takes part. Fruit of this international collaboration is an article which has been accepted recently for publication in the PNAS (Proceedings of the National Academy of Sciences of the United States of America) journal, one of the most important publications in general science in the world today.
This unification of criteria and the procedure will enable greater precision for future researchers. The incorrect use of the tools that existed gave rise to anomalies – at times not detecting genes in a fungus when, in fact, they existed, or vice-versa. Dr Lavín explained with an example: “one of the bioinformatic tools, known as BLAST, makes a comparison of sequences: you can take a gene of a pine tree and send it to the database to see what it is similar to. Imagine that, of all the genes the database has identified, none are like that of the pine except a mouse gene, but in a minimal part. The tool would place this result in a prime position; but this did not mean the mouse gene is the same as the pine gene, simply that the two had a small part that was very similar, although 99.9% is very different. This is what happened until now: researchers assumed that, because a result came out first, it meant two genes were the same. In fact, a series of requisites has to be complied with and this is what the researcher has worked on in his thesis: identifying each of the genes that are truly similar or orthologous; i.e. they comply the same function or a very similar function in two different organisms.
In collaboration with the Department of Mathematics at the Public University of Navarre, the development of the OXPHOS database is anticipated, and this will be available to the scientific community. What this means is that, when researchers need to carry out a study and search for these genes, they can refer to this database and, there being a high percentage of precision, they know the results are reliable. This database gathers the information of 27 fungi genomes already sequenced. The aim is that each time the genome of a new species of fungus is sequenced, the database incorporates this sequencing and the information available is extended.
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Article adapted by Medical News Today from original press release.
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Source: Oihane Lakar
Elhuyar Fundazioa
‘Think Before You Go To A&E’, Ask London NHS Trust And Tower Hamlets Primary Care Trust, England
“Is it really an emergency?” Going along to your nearest hospital’s Accident and Emergency is not necessarily the most responsible urgent care option open to the public this winter.
That’s the message of a London-wide campaign aimed at taking the strain off hospital A&E departments this winter. Now Barts and the London NHS Trust and Tower Hamlets Primary Care Trust are backing the campaign to help front-line services cope with increased demand at A&E over the winter.
Alastair Wilson, the Lead Clinician in the A&E department at The Royal London Hospital, is appealing to the public to think before coming to hospital. His own cold has lingered since the beginning of November, and he concedes he “is amazed by the insensitivity of some patients” so openly spreading their germs to others in the hospital precincts.
He said: “Over the last few weeks hundreds of patients with self limiting coughs, colds and flu have descended on the Emergency Department without concern for the vulnerable patients who could so easily be harmed as a result of catching even minor infections.
“Worse, individuals with diarrhoea and vomiting seem determined to spread their highly infectious germs amongst the elderly and infirm, rather than staying at home and seeking reassurance from their GPs.”
The NHS across London has seen a sustained increase in the number of people attending A&E for emergency treatment over recent weeks. This has been exacerbated further by the prolonged cold weather and the prevalence of flu and winter vomiting bugs affecting public and NHS staff alike.
The aim of the ‘Think before you go’ campaign is to urge Londoners to consider other ways of help before calling 999 or going to hospitals and A&E departments, so that hospital staff can care for those people who need emergency treatment the most.
Radio and local press adverts are advising people with non-urgent conditions to contact their local GP, NHS Direct, Walk-In Centres and pharmacists.
Key messages include:
- Hospitals in London are extremely busy during the winter so please help us to help you
- We need to make sure that A&E departments are able to care for the most seriously ill Londoners, so please think before going to your local A&E or calling 999
- There are many ways to get health advice and treatment near where you live
- GPs are now open for longer hours and you can also visit your nearby Walk-In Centre or ask for advice at your local pharmacist
- If you have flu-like symptoms or are suffering from diarrhoea and vomiting, stay at home and seek advice from your GP or NHS Direct
- For further health advice and information 24-hours a day, call NHS Direct on 0845 4647
Barts and the London NHS Trust
Cases Of MRSA Bacteraemia Cut By Almost Two-Thirds At Epsom, St Helier And Sutton Hospitals, England
Cases of MRSA bacteraemia continue to fall at Epsom, St Helier and Sutton hospitals.
Figures released by the Health Protection Agency (HPA) revealed that the number of cases of MRSA bacteraemia at the Trust fell to seven between July and September 2008. This compares to a total of 10 cases for the previous quarter (April – June) and a reduction of 63% to the same quarter the previous year.
Samantha Jones, Chief Executive, said: “The ongoing commitment of staff and volunteers has allowed us to achieve so much but we are not complacent.
“Patients and visitors should be assured that infection control remains our top priority and we will continue to do all we can to build on these successes and further reduce healthcare acquired infections.
“I hope they will also see how committed and determined we are to ensure their hospitals are even safer places in which to receive high quality services.
“However I would remind patients and visitors that they have a vital role to play too. It is very important that they wash their hands thoroughly with soap and water, especially after using the toilet and before eating.”
The Trust has introduced a number of high profile measures in its fight against healthcare acquired infections, including:
- Increasing the training given to all staff about infection control especially the importance of hand hygiene before and after clinical contact;
- Daily monitoring of devices and drips to ensure that we are providing the best care to patients;
- Introducing talking signs to remind ward visitors of the importance of hand hygiene;
- Carrying out a regular audit of hand hygiene in clinical areas;
- Extending our MRSA screening programme so that we can detect and treat it quicker;
- Undertaking a £300,000 deep clean of our hospitals and maintaining a programme of cleaning on the wards;
- Carefully prescribing antibiotics.
In addition, the Trust is about to launch a major hand hygiene awareness campaign targeted at staff, patients and visitors.
http://www.epsom-sthelier.nhs.uk
New Melanoma / Skin Cancer Channel On Medical News Today
Medical News Today is pleased to announce the launch of a new Melanoma / Skin Cancer channel. The section will include news on both types of skin cancer:
- malignant melanoma (a tumor of melanocytes)
- non-melanoma (basal cell and squamous cell carcinoma)
This section will also include news on melanomas that occasionally develop in the eyes (uveal melanoma), the respiratory passage, intestines and brain.
Medical News Today asks that any subscribers to the tailored Newsletter or Newsalert, who would like to receive the news from this new section in their e-mails, amend their preferences using the link provided in their last/next e-mail from Medical News Today (or use our feedback form if you would like assistance).
Other channels that have been added recently and will also need to be updated in the e-mail subscriptions include:
- Asbestos / Mesothelioma
- Back Pain
- Eczema / Psoriasis
- Lymphology/Lymphedema
- Medical Practice Management
- Menopause
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New Medical Practice Management Channel On Medical News Today
Medical News Today is pleased to announce the launch of a new Medical Practice Management channel. The section will include news on the business and operational aspects of managing a medical practice; billing, coding, collections, technology, work flow, staffing, compensation, lawsuits, legislation, and more.
Medical News Today asks that any subscribers to the tailored Newsletter or Newsalert, who would like to receive the news from this new section in their e-mails, amend their preferences using the link provided in their last/next e-mail from Medical News Today (or use our feedback form if you would like assistance).
Other channels that have been added recently and will also need to be updated in the e-mail subscriptions include:
- Asbestos / Mesothelioma
- Back Pain
- Eczema / Psoriasis
- Lymphology/Lymphedema
- Melanoma / Skin Cancer
- Menopause
- Ovarian Cancer
- Tuberculosis
- Veterans / Ex-Servicemen
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