10th June 2016

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Cardiac ‘bruising’ may predict worse heart attack

UK researchers say they have found a new way to tell if a heart attack is more severe and might cause lasting harm – by looking for bruising or bleeding in the heart muscle.

Patients with this sign on scans more often develop serious problems like heart failure, says the Glasgow team.

It’s hoped the discovery could help with preventing such complications.

 

Study says a major blood cancer is 11 distinct diseases

One of the main types of blood cancer is not one but 11 distinct diseases, detailed genetic analysis suggests.

A study in the New England Journal of Medicine found genetic differences explain why some patients respond much better to treatment than others.

The researchers say their findings should help with the development of clinical trials.

Cancer Research UK says this type of study offers new insights into cancer.

 

Ten years of hormone breast cancer drugs ‘may benefit some’

“Taking hormonal drugs for up to 15 years reduces the risk of breast cancers coming back,” BBC News reports.

A new study looked at 1,918 postmenopausal women with what is known as oestrogen receptor-positive (or ER+) breast cancers – where cancer growth is stimulated by the hormone oestrogen.

A class of drugs known as aromatase inhibitors are often used in such cases, as they are able to reduce the production of oestrogen.

The women had previously responded well to a five-year course of hormone treatments.

They were randomised into two groups: either they took an aromatase inhibitor called letrozole for another five years, or they were given a dummy treatment (placebo).

Disease-free survival after five years was 95% in the treatment group and 91% in the placebo group.

Extended aromatase inhibitor treatment cut the risk of recurrent or new breast cancer development by about a third.

Osteoporosis was the most significant side effect from extended treatment with letrozole.

However, there was no effect on overall survival, and no effect on disease-free survival when taking into account baseline differences between the participants.

It is hoped further evidence will be forthcoming to identify which women – in terms of characteristics, stage of breast cancer and prior treatment – may be most suited to this treatment, and for whom the benefits of prolonged treatment would outweigh the side effects.

 

 

6th May 2016

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Diluted apple juice ‘as good as’ rehydration drinks for children

“Scientists have revealed which fruit can stop toddlers crying due to stomach pains,” says the Daily Mirror, missing the point of the study it reports on.

The study looked at the use of diluted apple juice to prevent dehydration in children with upset stomachs.

When children get diarrhoea or vomiting, the main danger is that they will lose too much fluid (become dehydrated). Severe dehydration can be life-threatening and can happen quickly in young children.

To prevent this, doctors often recommend giving them specially made rehydration drinks, with a mixture of salts and sugars designed to keep fluid levels stable. However, the drinks are expensive and some children don’t like the taste.

The researchers wanted to see if rehydration drinks were actually better, or if drinking diluted apple juice followed by children’s usual preferred drinks would work just as well for children aged over six months.

The study found that children given apple juice were less likely to need additional treatments – possibly because they were happier with the taste and more willing to drink the juice.

However, this may not work for all children, as the study didn’t include any babies under six months, children with more serious stomach upsets or other conditions, and those who were already severely dehydrated.

 

Cardiff University microwave device to help diabetics

Scientists have created a portable blood glucose measure for diabetics which uses microwaves instead of pricking the skin.

Currently, diabetics have to test their blood several times a day or use inserted devices known as continuous blood glucose monitors (CGMs).

But a new monitor created by Cardiff University’s School of Engineering can be discreetly stuck on to the skin.

Prof Adrian Porch said: “It will help with the management of the condition.”

He added: “Conventional methods of monitoring blood glucose require the extraction of blood.

“Our device is non-invasive – it does not require the extraction of blood apart from the initial calibration.”

 

New drugs for aggressive prostate cancer ‘promising’

A new type of drug could benefit men with aggressive prostate cancer that is no longer responding to treatment, researchers from the Institute of Cancer Research have said.

In a study on mice, Hsp90 inhibitors were found to strip cancer cells of defences against hormone treatments.

This makes the drugs particularly promising for treating drug-resistant cancers, the research team said.

Prostate cancer is the most common cancer in men in the UK.

 

Breast cancer: Scientists hail ‘milestone’ genetic find

Scientists say they now have a near-perfect picture of the genetic events that cause breast cancer.

The study, published in Nature, has been described as a “milestone” moment that could help unlock new ways of treating and preventing the disease.

The largest study of its kind unpicked practically all the errors that cause healthy breast tissue to go rogue.

Cancer Research UK said the findings were an important stepping-stone to new drugs for treating cancer.

To understand the causes of the disease, scientists have to understand what goes wrong in our DNA that makes healthy tissue turn cancerous.

The international team looked at all 3 billion letters of people’s genetic code – their entire blueprint of life – in 560 breast cancers.

They uncovered 93 sets of instructions, or genes, that if mutated, can cause tumours. Some have been discovered before, but scientists expect this to be the definitive list, barring a few rare mutations.

 

Obese patients denied surgery in a third of areas in England

Surgeons are worried overweight patients and smokers in England and Wales are being denied surgery to save money.

A report by the Royal College of Surgeons found a third of local NHS health bosses in England put restrictions on access to surgery.

But it says this goes against official guidance and can prolong patient pain.

However, some local NHS groups criticised in the report say their polices are based on good evidence.

The Royal College of Surgeons has been increasingly alarmed about the rationing of surgery in the NHS in the tough financial climate.

Its report is based on freedom of information returns from nearly all of the 209 clinical commissioning groups in England and all seven health boards in Wales.

While some CCGs have voluntary policies in place, where patients are encouraged to stop smoking or lose weight, others have introduced mandatory policies, which means patients have to meet fixed criteria before surgery.

 

Final piece of type 1 diabetes puzzle solved

A complete picture of the areas that the immune system attacks to cause type 1 diabetes has finally been revealed by scientists.

The study, published in the journal Diabetes, discovered the fifth and final critical target at which the immune system errantly takes aim.

The team at the University of Lincoln say the findings could help develop new ways to prevent and treat the disease.

22nd April 2016

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Would you trust a smartphone app as a contraceptive?

“An innovative new app might provide a more effective form of birth control than the contraceptive pill,” The Sun reports.

The Natural Cycles fertility app combines the use of a thermometer to measure body temperature with calendar calculating methods – often referred to as the rhythm method – to work out the days when a woman would be at high or low risk of pregnancy.

More than 4,000 women were included in this Swedish study looking at how effective the app is at preventing pregnancy.

A total of 143 unplanned pregnancies occurred during the study period, 10 of which were the result of the app falsely indicating a safe day.

Data collected by the app was used to work out that, if used exactly as advised, 5 women out of every 1,000 will accidentally become pregnant, and 7 out of every 100 women will become pregnant for “typical use” (not using the app correctly), each year.

This app may be attractive for women who are unwilling to use other forms of contraception, possibly for religious or cultural reasons, or because they have concerns about the side effects of hormonal contraception.

This app may also help indicate the best days to try to conceive.

But an obvious disadvantage of this contraceptive method is that the app does not protect against sexually transmitted infections in the same way as a condom.

 

Skin cancer: Pair of drugs ‘eliminate 20% of tumours’

A fifth of people with advanced melanoma have no sign of tumours in their body after treatment with a pair of immunotherapy drugs, a study shows.

The first survival data on using ipilimumab and nivolumab in combination showed 69% of patients, in a trial on 142, were still alive after two years.

UK doctors leading the trial said the results were “very encouraging”.

Melanoma, the most serious form of skin cancer, is the sixth most common cancer in the UK

It kills more than 2,000 people in Britain each year.

More studies on the emerging field of immunotherapy will be presented later.

 

Protein injection hope for Alzheimer’s

Scientists believe injections of a natural protein may lessen the symptoms and progress of Alzheimer’s dementia after promising early trials in mice.

The treatment – IL 33 – appeared to improve memory and help clear and prevent brain deposits similar to those seen in people with Alzheimer’s.

Tentative human studies of the treatment will soon begin, but experts say it will take many years to know if it could help patients in real life.

The work is published in PNAS journal.

 

Head and neck cancer drug ‘game changer’

A new type of cancer drug that wakes up the patient’s own immune system to fight tumours could be a game changer for tackling aggressive head and neck cancers, say experts.

Trial results coming out of a US cancer conference suggest the treatment works better than standard chemotherapy.

Nivolumab significantly improved the survival odds of patients with these hard-to-treat tumours.

It is already available on the NHS for people with advanced skin cancer.

But experts say more research is needed before offering it routinely to patients with other cancers.

 

Type-1 diabetes ‘prevention’ trial starts in Scotland

A major trial is set to start in Scotland aimed at preventing type-1 diabetes in children.

Researchers are preparing to contact all 6,400 families in the country affected by the condition.

Children who have a parent or sibling with type-1 diabetes will be invited for a blood test to see if they are at high risk of developing the disease.

Those at risk will be offered a drug called metformin to see if it can hold off diabetes.

Metformin is already used to treat diabetes, but it is not clear if it might prevent it from developing in the first place.

If successful, the study could challenge long-established thinking on what lies behind type-1 diabetes.

 

15th April 2016

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Is the NHS in England stuck with soaring demand?

The latest batch of monthly figures from the NHS in England suggest a service that’s struggling to keep up with demand.

Once again, many of the main performance targets – including ambulance response times, delays in A&E, and treatment for cancer – have been missed

All this against a background of increased attendances, more referrals and GPs being busier than ever

So is the NHS is stuck in a never-ending cycle of soaring demand?

‘Unacceptable gaps’ in NHS baby transfer service

There are completely unacceptable gaps in NHS services designed to help sick and premature babies, a child health expert says.

A snapshot survey by the charity Bliss showed neonatal transport services in the UK were understaffed and under-resourced.

The charity says some babies are having to wait too long for life-saving care.

But NHS England says care is as good as other European countries, despite growing demand.

Can HRT in early menopause cut heart disease risk?

“Women who take HRT drugs soon after going through menopause are ‘less likely to suffer heart disease’,” the Daily Mail reports.

A new study found that early adopters of hormone replacement therapy (HRT) might slow their progression toward atherosclerosis (hardening and thickening of the arteries) which can increase the risk of heart disease, heart attacks or strokes.

However, the study in question did not follow the women long enough to see if this would have a significant impact on heart health outcomes.

This study found women taking HRT (specifically, an oestrogen pill with or without progesterone vaginal gel) less than six years after their menopause began, had slower rates of artery wall thickening than women taking a dummy placebo pill. Artery wall thickening is a sign of atherosclerosis progression.

Artery wall thickening was the main way atherosclerosis progression was tested, but other measures showed no difference, so the results were a mixed bag.

Women taking HRT 10 or more years after menopause showed no difference in atherosclerosis progression compared with a placebo, suggesting the timing of HRT use post-menopause was important. The 643 women in the study, its randomised double-blind design, and average follow-up of five years, help build confidence in the study.

The main ambiguity is whether the differing rates of artery thickening observed here are big enough to have an impact on a woman’s risk of heart attack or stroke over the longer term.

Vitamin D ‘heals damaged hearts’

Vitamin D supplements may help people with diseased hearts, a study suggests.

A trial on 163 heart failure patients found supplements of the vitamin, which is made in the skin when exposed to sunlight, improved their hearts’ ability to pump blood around the body.

The Leeds Teaching Hospitals team, who presented at a meeting of the American College of Cardiology, described the results as “stunning”.

The British Heart Foundation called for longer trials to assess the pills.

Vitamin D is vital for healthy bones and teeth and may have important health benefits throughout the body but many people are deficient.

New drug ‘effective’ for those with intolerable statin side effects

“A breakthrough drug can slash levels of bad cholesterol by half without the side effects of statins,” the Daily Mail reports.

Statins are a class of drug used to reduce high cholesterol levels, they are often given to people thought to be at risk of heart disease or stroke.

A complaint from some people who take statins is that they seem to trigger muscle pains and spasms. In some cases, these side effects are so troublesome that a person stops taking the drug all together.

This study included almost 500 people who previously had muscle problems when they tried several types of statin.

They were randomised to take either low-dose atorvastatin or inactive placebo, and were unaware of which drug they were taking. The researchers found just under half reported muscle problems when taking the statin only.

These people were then randomised to take two alternative non-statin drugs – oral ezetimibe or the new injected drug evolocumab. Overall, researchers found the latter was better at reducing cholesterol.

One practical consideration regarding evolocumab is its cost. The drug is expensive: a year’s supply is reported to cost £4,450.

The National Institute for Health and Care Excellence (NICE) is reported to be making a final decision about whether evolocumab should be offered on the NHS and, if so, in what circumstances.

People should continue to take their statins as prescribed, but anyone with unexplained muscle aches and pains should report these to their doctor. Lowering the dose or trying a different type of statin may help relieve these symptoms.

Asthma ‘over-diagnosed and trivialised’

Too many children are being incorrectly diagnosed with asthma, with inhalers being dispensed for no good reason and becoming almost “fashion accessories”, say two specialists in the illness.

Prof Andrew Bush and Dr Louise Fleming warn that although steroid inhalers are life-saving when used properly, their side-effects should not be ignored.

And they call for more objective, careful diagnoses.

Meanwhile charity Asthma UK says better tests are urgently needed.

1st April 2016

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Diabetes drug linked to increased bladder cancer risk

“The anti-diabetic drug pioglitazone raises the risk of bladder cancer by 63 per cent,” The Daily Telegraph reports.

While the actual increased risk in real-world terms is small, the results may help to inform prescription decisions for both doctors and patients. Pioglitazone is a drug that helps people with type 2 diabetes by making their cells more sensitive to insulin.

Some previous studies have linked pioglitazone with a raised chance of bladder cancer, although the results of previous research have been inconclusive.

The new study looked at what happened to 145,806 people who took pioglitazone compared to other oral diabetes drugs (not insulin) over a 14-year period (2000 to 2014).

Researchers found that people who had taken pioglitazone, as opposed to other diabetes drugs, were 63% more likely to have been diagnosed with bladder cancer, and that the risk increased the longer they had taken it.

It is important to note that the overall risk of bladder cancer was low. There were 121 cases of bladder cancer for every 10,000 people taking pioglitazone for 10 years, compared to 89 cases for people taking other diabetes drugs.

For people who respond well to this drug, the benefits in terms of diabetes control are thought to outweigh the risks.

Anyone taking pioglitazone should continue the drug as prescribed, but discuss any concerns they have with their doctor, and immediately report any symptoms such as blood in urine, frequent urination, or pain when passing urine.

 

Could a very low calorie diet ‘cure’ type 2 diabetes?

“Dieting for just eight weeks can reverse your diabetes,” the Daily Mail reports.

A small study of 30 people with type 2 diabetes found eight weeks on a very low calorie diet of around 600 to 700 calories a day, followed by a less radical six-month weight control diet, led to significant improvement in blood glucose levels in 12 people.

These findings are interesting: type 2 diabetes tends to be seen as a long-term condition that often gets worse over time or, at best, can be kept in check by medication, rather than one that could be reversed.

Tests found the 12 people had glucose levels below the usual cutoff for diabetes, measured after they switched to the weight control diet, which lasted over the next six months.

People who saw their glucose levels return to normal tended to be younger and have had diabetes for a shorter period.

Although the results are encouraging, the study did not compare a low-calorie diet with other treatments.

Another practical consideration is the issue of compliance. The study was self-selecting in that people responded to an advert, which suggests they were highly motivated to lose weight.

Whether the general population of people with type 2 diabetes would stick to a very low calorie diet is uncertain.

We now need bigger, longer-term studies to find out how feasible this is as a treatment approach for more people with type 2 diabetes.

 

 

Mindfulness may be effective for treating lower back pain

“Meditation could ease the agony of back pain, a study suggests,” the Daily Mirror reports.

A US study compared a technique called mindfulness-based stress reduction (MBSR) with usual care and cognitive behavioural therapy (CBT) for long-term non-specific lower back pain. The term “non-specific” refers to when there are no obvious causes, such as a slipped disc.

MBSR is based on yoga methods, such as meditation, yoga postures and an increased self-awareness of your thought patterns.

Participants were split into three groups. Those allocated to either MBSR or CBT were given eight weekly training sessions. Follow-up was performed after six months and 12 months.

At both of these time points, MBSR significantly improved functional disability and pain compared with usual care – but not when compared with CBT. Both MBSR and CBT were as effective as each other.

Access to NHS-funded CBT can be limited in some parts of the country. A practical advantage of MBSR is that you can learn more about it without a therapist, such as by watching an online video or reading a training manual.

Despite the media headlines, the study did not compare these therapies with painkillers directly – only “usual care” which, frustratingly, was not further described.

Nor do the findings suggest that people with identified causes for their back pain – such as a slipped disc, trapped nerve or inflammatory disease – should just meditate and it’ll all go away. These conditions would need investigation and treatment appropriate to the underlying cause.

 

 

Birth care variation in hospitals in England ‘concerning’

The variation in care women get when giving birth in hospital in England is concerning, experts say.

The Royal College of Obstetricians and Gynaecologists’ warning follows a review of more than 550,000 births.

It found “substantial variation” in practice between maternity units, and said this may suggest not all women get the best possible care.

Ministers said the NHS was a safe place to give birth but the report would help it improve.

The review – carried out with the London School of Hygiene and Tropical Medicine – looked at official data on births in 2013-14, excluding non-standard deliveries such as twins, triplets and pre-term babies.

It highlighted different rates of emergency caesarean sections, instrumental deliveries and episiotomies, which is when the area between the vagina and anus is cut.

In some maternity units 8% of mothers needed emergency c-sections, but in others the figure was 15%.

Just under one in five first-time mothers needed help with instruments while giving birth naturally in some units – but in other units this figure rose to almost three in 10.

The number of women who needed an episiotomy ranged from 29% to 44%.

RCOG president Dr David Richmond said: “We are concerned about the amount of variation identified in this report.

“Although the exact causes are difficult to establish, it is paramount that maternity units have information about their services, as well as the ability to compare themselves to the national average and to their peers.”

17th March 2016

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Not enough doctors for 7-day NHS, says Royal College head

There are not enough doctors to run a seven-day NHS in England, according to a leading doctor.

In a speech on Tuesday, Royal College of Physicians president Prof Jane Dacre will warn ministers the issue must be addressed if their policy is to work.

She will highlight research that shows vacant posts are not being filled and gaps in rotas are being seen.

It comes as ministers are locked in a dispute with junior doctors over their plans for improving weekend care.

 

Quitting smoking overnight ‘better than cutting down gradually’

“Want to quit smoking? Forget trying to cut down, if you really want to kick the habit ‘going cold turkey is the best option’,” is the headline from the Mail Online.

The news website reports on a trial by UK-based researchers that aimed to assess whether it’s better to stop smoking gradually or abruptly.

The researchers included almost 700 people and randomly assigned them to a gradual or abrupt stop in cigarette use. After four weeks, 39.2% of participants that gradually stopped smoking were still abstinent, compared with 49.0% that stopped smoking abruptly.

Both groups had access to nicotine replacement therapy (NRT), such as patches or gum, after the quit day. At six months, the proportion of participants that still abstained from smoking had reduced to 15.5% in the gradual group and 22.0% in the abrupt group.

The findings of this trial show promise, but going “cold turkey”, as the headline suggests, may not be for everyone.

That said, setting a designated “quit day” can be useful, as you can put into place “strategies” that can help you improve your chances of quitting.

These include getting adequate stocks of NRT, or even something as simple as finding something to do with your hands – some people find worry beads very useful.

 

43% ‘resume smoking after giving birth’

Nearly half of women who quit smoking during pregnancy take it up again soon after they give birth, according to research in the journal Addiction.

The analysis of several studies suggests 13% of women who enrol on smoking cessation programmes quit during pregnancy.

But 43% of these restart within six months of giving birth.

Public Health England says more action is needed to help mothers-to-be quit for good.

1ST March 2016

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New blood test can detect a range of inherited heart conditions

“A new blood test could help diagnose people with inherited heart conditions,” BBC News reports.

Inherited heart conditions affect around 1% of the population, and can disrupt the normal functioning of the heart – sometimes with fatal results.

Sometimes a family is only aware they may be at risk of an inherited heart condition when one of the family members dies suddenly, often when exercising.

It is hoped this new test will allow for a more efficient diagnostic protocol for people who are thought to have these conditions. If a condition is present, this should lead to better and earlier management.

There are already methods in use to detect inherited heart conditions, but the researchers wanted to find a method that would cover all genes currently known to be involved in causing such conditions.

They developed a single test that covered 174 genes known or suspected to cause more than 17 different types of inherited heart conditions.

The researchers found their approach had advantages over existing methods, in that it assessed more genes, was quicker, gave more in-depth information than the existing methods it was tested against, and cost less.

The researchers state this test is for research purposes and, ultimately, use in wider clinical practice.

According to the media, the test is already in use at the Royal Brompton and Harefield NHS Foundation Trust, which is where some of the researchers work. If successful, it may be rolled out across the NHS.

Virtually all hospitals now in deficit

Nearly every hospital in England is now in deficit as financial problems in the NHS threaten to spiral out of control.

Of the 138 hospital trusts, just seven are still in surplus according to the 2015-16 third quarter accounts, which cover April to December.

The figures also showed a total NHS trust overspend of £2.26bn once ambulance, mental health and community services were taken into account.

Experts said performance was deteriorating at an “alarming rate”.

Better births: improving outcomes of maternity services in England: a Five year forward view for maternity care

NHS England –  This is the final report of the NHS England commissioned review into the future of maternity services in England. It finds that despite the increases in the number of births and the increasing complexity of cases, the quality and outcomes of maternity services have improved significantly over the last decade. However, the review also found meaningful differences across the country, and further opportunities to improve the safety of care and reduce still births. It highlights seven key priorities to drive improvement: personalised care; continuity of carer; better postnatal and perinatal mental health care; safer care; a fairer payment system for providers; increased multi-professional working; and working across boundaries to provide and commission maternity services.

• Report

NHS to help create ‘healthy new towns’

Ten new housing developments in England are to be built with healthy living in mind, under an NHS scheme.

Clinicians, designers and technology experts will work together to create the “healthy new towns”.

Plans include homes with virtual access to GP services, safe green spaces to play and fast-food-free zones around schools.

The money to build the developments will come from council budgets and private partners rather than the NHS.

The places earmarked to test the ideas include existing villages in the South West, London and the North West and two new developments in Cambridgeshire and Darlington.

Meningitis B petition rejected

Offering the meningitis B vaccine to all children is “not cost effective” and would be a waste of NHS money, the government says.

Public support for extending the vaccine grew after the mother of two-year-old Faye Burnett shared pictures of her dying from the infection.

The jab is offered to children in their first year of life.

But more than 800,000 people signed a petition for it to be given to all children under 11.

In response to the most popular petition in parliamentary history, the Department of Health said it was following the expert advise of its Joint Committee on Vaccination and Immunisation (JCVI).

It said: “With this programme, our priority is to protect those children most at risk of Men B, in line with JCVI’s recommendation.

“The NHS budget is a finite resource, it is therefore essential that JCVI’s recommendations are underpinned by evidence of cost-effectiveness.

“Offering the vaccine outside of JCVI’s advice would not be cost effective, and would not therefore represent a good use of NHS resources which should be used to benefit the health and care of the most people possible.”

It added: “When any new immunisation programme is introduced, there has to be a cut-off date to determine eligibility.

“While this is extremely difficult for parents whose children aren’t eligible, there is no other way of establishing new programmes to target those at highest risk without introducing inequalities.”

The UK is the only country in the world to offer the vaccine routinely to children of any age.

It is offered only in the first year of life when infants are most vulnerable to the infection.

The issue is still scheduled to be debated in the House of Commons.

18th February

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The future of child health services: new models of care

Nuffield Trust –

This report highlights what the problems are in current health care services for children and young people, and investigates how emerging new models of care could provide an opportunity to address these.
Briefing

 

Excitement at new cancer treatment

A therapy that retrains the body’s immune system to fight cancer has provoked excitement after more than 90% of terminally ill patients reportedly went into remission.

White blood cells were taken from patients with leukaemia, modified in the lab and then put back.

But the data has not been published or reviewed and two patients are said to have died from an extreme immune response.

Experts said the trial was exciting, but still only “a baby step.”

The news bubbled out of the American Association for the Advancement of Science’s annual meeting in Washington DC.

The lead scientist, Prof Stanley Riddell from the Fred Hutchinson Cancer Research Centre in Seattle, said all other treatments had failed in these patients and they had only two-to-five months to live.

He told the conference that: “The early data is unprecedented.”

 

NHS to get £4bn in drive for ‘paperless’ health service

The government has launched its latest attempt to improve the use of technology in the NHS in England.

The aim is to create a paperless service that would be more convenient for patients, and help doctors to provide faster diagnoses.

More than £4bn has been set aside for areas such as electronic records and online appointments, prescriptions and consultations.

But Labour said the NHS was “going backwards” under the Conservatives.

Full details of the funding are being agreed between the Department of Health and NHS England, but are expected to include:

• £1.8bn to create a paper-free NHS and remove outdated technology like fax machines
• £1bn on cyber security and data consent
• £750m to transform out-of-hospital care, medicines and digitise social care and emergency care
• About £400m to build a new website – nhs.uk – develop apps and provide free wi-fi

Health Secretary Jeremy Hunt said doctors found filling out paperwork and bureaucracy “so frustrating”.

“We know that proper investment in IT – it’s not without its pitfalls – can save time for doctors and nurses and means they can spend more time with patients,” he told the BBC’s Andrew Marr Show.

The aim is to allow patients to book services and order prescriptions online, access apps and digital tools and choose to speak to their doctor online or via a video link.

 

Hope that blood test ‘could diagnose five types of cancer’

“A new blood test that detects five different forms of cancer is one step closer to becoming a reality and could save millions of lives around the world,” the Mail Online reports. The test looks for abnormal changes in DNA – what is described as a DNA signature.

This laboratory research looked at ways to identify tumour DNA – DNA affected by abnormal cell growth – in blood samples and distinguish it from normal cellular DNA.

The researchers used tissue samples from five cancers – womb, lung, stomach, colon and breast tumours – and compared it with normal healthy tissue.

In brief, they found they could identify the cancerous tissue from a particular DNA signature around a certain gene (ZNF154).

Their tests reveal this test could be fairly accurate at detecting cancer at a concentration of 1% tumour DNA on a background of 99% normal DNA in a blood sample.

There are many things to consider before any new screening or diagnostic test for cancer is introduced, especially with a “blanket screen” like this.

These issues include how and whether the test improves on current screening or diagnostic methods, as well as looking at the possible harmful effects, such as getting an incorrect positive screen result when you’re in fact cancer free, or getting an incorrect negative screen result when you have cancer.

 

Record rise in NHS dissatisfaction levels – survey says

The biggest ever rise in public dissatisfaction with the NHS was recorded last year, according to a long-running survey.

The British Social Attitudes Survey has been tracking satisfaction since 1983.

The 2015 poll of nearly 2,200 people showed satisfaction with the NHS at 60% – down from a peak of 70% in 2010.

Some 23% said they were actively dissatisfied – a rise of eight percentage points on the year before and the biggest single jump in a year.

Waiting times were cited as the biggest reason for dissatisfaction – mentioned by over half of people – followed by there being not enough staff.

The findings come amid growing pressure on waiting times for cancer care, A&E and routine operations, such as knee and hip operations.

Patients reported highest satisfaction rates for GP services and lowest for social care, which is run by local authorities and covers home help for tasks such as washing and dressing, and care homes.

The survey – carried out by NatCen Social Research – covered Scotland, Wales and England. The differences between the three nations were not considered to be statistically significant.

5th February 2016

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Proton beam therapy ‘effective’ and ’causes fewer side effects

“Proton beam cancer therapy ‘effective with fewer side effects’,” BBC News reports. A US study found the technique caused fewer side effects than conventional radiotherapy.

Proton beam therapy hit the headlines in 2014 due to the Ashya King case – with his parents removing him from hospital without the knowledge of staff to receive this treatment abroad. The technique is an alternative to standard radiotherapy. In this study, it was used to treat a malignant brain tumour called medulloblastoma in 59 children.

Medulloblastomas can be cured with a combination of surgery, chemotherapy and radiotherapy. However, standard “photon” radiotherapy is associated with a risk of long-term complications for the child, including hearing problems and cognitive (brain function) impairment.

Photon beam therapy uses beams of protons (sub-atomic particles) to destroy cancerous cells. Unlike conventional radiotherapy, the beam of protons stops once it “hits” the cancerous cells. This results in much less damage to surrounding tissue.

In this study, 16% of the children had serious hearing loss five years after proton beam therapy. This compares favourably with standard radiotherapy, where about 25% have hearing loss. Cognitive impairment was also slightly less – 1.5 intelligence points (IQ) lost per year, compared with 1.9 in studies of standard radiotherapy. Overall survival was reported to be similar to standard radiotherapy. The main limitation is that this was not a randomised controlled trial directly comparing the two forms of radiotherapy – the researchers said this would be unethical.

The results seem promising and the researchers hope their study will pave the way for other studies examining safety and survival outcomes of proton beam radiotherapy in other cancers.

 

Care for bereaved parents ‘must improved

Bereavement services for families whose babies are stillborn or die shortly after birth are “not good enough”, a government health minister has said.

It follows an investigation by Conservative MP Antoinette Sandbach who found services were “patchy” with some parents unable to access help.

She broke down in the Commons last year as she spoke about losing her own baby.

Neonatal care minister Ben Gummer said he was working to ensure there was consistent support across the UK.

 

Cancer death rates down by 10% in 10 years

Cancer death rates in the UK have fallen by about 10% in the past 10 years, the latest figures show.

In 2013, 284 out of every 100,000 people died from cancer. In 2003, it was 312. Improvements in diagnosis and treatment are thought to be the reason.

The death rate for men fell 12% and for women by 8%, narrowing the gender gap.

But the actual number of cancer deaths rose – from 155,000 in 2003 to 162,000 in 2013 – as more people live longer and develop the disease in old age

“The population is growing, and more of us are living longer,” Cancer Research UK chief executive Sir Harpal Kumar said.

Almost half of all the cancer deaths in 2013 were from lung, bowel, breast or prostate cancer.

Although the combined death rate for these four cancers had dropped by about 11% over the past 10 years, some other cancers, such as liver and pancreatic, had increased death rates.

Sir Harpal said: “Too many people are still being diagnosed with and dying from cancer, not just here in the UK but around the world.”

He said CRUK was focusing research on how to achieve earlier diagnosis and manage hard-to-treat cancers.

“Our scientists are developing new tests, surgical and radiotherapy techniques, and drugs,” he said.

“It’s important to celebrate how much things have improved, but also to renew our commitment to saving the lives of more cancer patients.”

Cancer Research UK compiled the cancer death rate data, which was taken from cancer registries in England, Wales, Scotland and Northern Ireland.

 

Just one hour of sitting down may increase diabetes risk by a fifth

“Every extra hour sitting down can raise your risk of type 2 diabetes by a fifth,” the Daily Mirror reports. The paper reports on a study that used an accelerometer – a device that tracks movement – to look at the effects of sedentary behaviour on type 2 diabetes risk.

Researchers in the Netherlands measured the time that almost 2,500 middle-aged or older people spent sitting or lying down in one week, using an accelerometer. They found that people who had type 2 diabetes spent on average 26 minutes longer sitting or lying down, compared to people without diabetes.

From this, the researchers calculated that each additional hour of being sedentary increased the chances of a person having diabetes by 22%. It made little difference whether people sat for long periods or got up for regular breaks – the important thing was the overall amount of time spent sedentary.

Importantly, the study doesn’t tell us if people’s sedentary behaviour led to them getting diabetes, or whether people became more sedentary after getting diabetes. However, it provides more evidence that spending a lot of time physically inactive is likely to be bad for our health.

 

Hospital bed-blocking ‘costs’ NHS England £900m a year

Delays in discharging patients out of hospital after treatment could be costing the NHS in England £900m a year, an independent review has said.

Labour peer Lord Carter’s report found nearly one in 10 beds was taken by someone medically fit to be released.

It said it was a “major problem” causing operations to be cancelled and resulting in the NHS paying private hospitals to see patients.

Union Unison said cuts to social care were a major cause of “bed-blocking”.

Lord Carter identified the issue in a wider look at how £5bn could be saved by 2020.

His proposals called for better procurement and staff management, and savings to the drugs bill.

But delayed discharges are likely to be prove a more intractable problem as it is largely not down to the actions of hospitals.

Vulnerable and frail patients cannot be released if there is not the support in the community from home care workers or district nursing staff or a place in a care home.

While official statistics suggest about 5,500 patients a day are affected, the report said information provided by trusts estimates as many as 8,500 beds in acute trusts were being blocked.

It said if you take into account how much staffing and running a bed costs this works out at £900m a year.

But the true cost could be even higher. The report highlighted the growing trend to pay private hospitals to do NHS work, such as knee and hip operations, as a consequence of this.

Last year the NHS spent £11bn in the private sector – a rise of 11% on the previous year. Lord Carter said delayed discharges was likely to be a “contributory factor” in this.

Delayed discharges have also been blamed as one of the causes of growing waiting times in A&E as doctors struggle to find beds for patients who need to be admitted.

 

29th January 2016

GO BACK TO THE LIBRARY HOMEPAGE

 

Emergency services ‘should share control rooms’

Police, fire and ambulance services in England should share control rooms to improve their response to 999 calls, a Home Office minister has said.

Mike Penning said it did not “make sense” to have different premises.

It comes as new plans are published to get the services working more closely.

There are also proposals for police and crime commissioners (PCCs) to oversee fire brigades, which could include choosing an officer in charge of hiring and firing fire and police staff.

This top officer post would be open to senior officers from both the police and fire service. They would hold the rank of chief constable – and to allow this the government would remove the current rule that holders of the rank must have served as a constable.

In most parts of England, police, fire and ambulance services have separate control centres and when someone rings 999, they have to tell an operator which service they need.

Emergency services in some areas – including Northamptonshire and Hampshire – are already working on joint schemes, but the Home Office wants more and is introducing a “statutory duty” on the three services to collaborate.

 

Balloon ‘last chance treatment’ for heart failure

Scientists have used a pioneering balloon technique as a “last chance” treatment to help a patient with severe heart failure.

Richard Reach, 59, had the balloon device implanted to close off a leaky heart valve, after he was told he was too unwell to have open heart surgery.

Doctors at King’s College Hospital say the procedure allowed him to improve enough to have more permanent surgery.

With further trials, the device could help thousands more patients, they say.

 

‘Remixed’ skin cells could lead to new diabetes treatments

“End of injections in sight for diabetics after new discovery,” says The Daily Telegraph. If you think you’ve read a similar headline before, you may be right – replacing insulin injections for type 1 diabetes has been a goal for many years.

Type 1 diabetes happens when the body’s immune system mistakenly attacks and destroys insulin-producing beta cells in the pancreas. Without insulin, people cannot control the levels of sugar in the blood.

High blood sugar levels (hyperglycaemia) can damage the blood vessels and nerves, while low blood sugar levels (hypoglycaemia) can cause unconsciousness. Most people with type 1 diabetes need to inject insulin regularly.

In this research, scientists from the University of California report they have used a new process to modify human skin cells into working pancreas cells. They say these cells produced insulin in the laboratory, and seemed to protect mice from diabetes when transplanted into their kidneys.

The hope is that by transplanting new beta cells formed from the person’s own skin cells, the pancreas will be able to make insulin again.

The advantage of being able to use skin cells is that cells could be taken from a person’s own body and retransplanted after adaptation, meaning they would be less likely to be rejected by the immune system.

This early-stage research is exciting, but much more work is needed before we’ll know whether this could become a treatment to replace insulin injections.

 

Blocking brain inflammation ‘halts Alzheimer’s disease’

Blocking the production of new immune cells in the brain could reduce memory problems seen in Alzheimer’s disease, a study suggests.

University of Southampton researchers said their findings added weight to evidence that inflammation in the brain is what drives the disease.

A drug used to block the production of these microglia cells in the brains of mice had a positive effect.

Experts said the results were exciting and could lead to new treatments.

Up until now, most drugs used to treat dementia have targeted amyloid plaques in the brain which are a characteristic of people with the Alzheimer’s disease.

But this latest study, published in the journal Brain and funded by the Medical Research Council and Alzheimer’s Research UK, suggests that in fact targeting inflammation in the brain, caused by a build-up of immune cells called microglia, could halt progression of the disease.

Researchers found increased numbers of microglia in the post-mortem brains of people with Alzheimer’s disease.

Previous studies have also suggested that these cells could play an important role.

 

Arthritis drug could also help combat ovarian cancer

“A rheumatoid arthritis drug can kill off ovarian cancer cells in women with the BRCA1 mutation,” the Mail Online reports. The drug, auranofin, was found to be effective against ovarian cancer cells associated with the BRCA1 mutation.

The BRCA1 gene – along with a similar gene called BRCA2 – is designed to repair damage to DNA as cells divide. The absence of this ability increases the risk of cells developing abnormalities that can trigger ovarian cancer, as well as breast cancer.

This study was laboratory research examining the effect of the arthritis drug, auranofin, on ovarian cancer cells with and without BRCA1 mutation. Auranofin is not currently licensed in the UK.

When ovarian cancer cells were treated with auranofin in the lab, researchers found the drug’s cancer-killing properties were most effective at treating ovarian cancer cells lacking a “healthy” version of the BRCA1 gene.

It seemed auranofin caused damage to the DNA of cancerous cells with BRCA1 mutations, helping to kill them. The results suggest there may be promise for this drug in the treatment of ovarian cancers associated with BRCA1 mutations.

Although auranofin is currently used in the treatment of rheumatoid arthritis in the US, and has been tested in early-stage ovarian cancer studies in humans, much more study is needed looking into its effectiveness and safety before it could be approved for use in the treatment of ovarian cancer.

 

Pattern of brain chatter ‘clue to anaesthesia response’

Taking readings of brain activity before patients go for surgery could help doctors give a more accurate dose of anaesthetic, researchers suggest.

At present, a patient’s body weight is the main factor in deciding the dose.

But a University of Cambridge study indicated people with high levels of brain connectivity or “chatter” needed a larger dose to put them under.

And this could help doctors work out exactly the amount of anaesthetic a patient requires to become unconscious.

The study, published in PLOS Computational Biology, looked at how the brain’s electric signals changed in 20 healthy volunteers given a common anaesthetic called propofol.

They were then asked to press different buttons when they heard different sounds.

After reaching the maximum dose, some were still pressing buttons, while others were unconscious.

The “chatter” or connectivity between areas of the brain was much more pronounced in those who were still conscious.

And when the research team looked at brain activity when the participants were awake, using readings from an electroencephalogram (EEG), they found similar differences.