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Child swine flue jab: the trial begins

The study to determine the better of two swine-flu vaccines for children aged between 6 months and 12 years is currently underway. Around 1,000 children are taking part in the voluntary scheme in Oxford, Southampton, London, Bristol and Devon where they will receive two doses of the vaccine three weeks apart, followed by a blood test three weeks later. The study will determine immune reactions, particularly against swine-flu, and compare the side effects of each vaccine.

The step to immunise children, who it is well known easily spread flu epidemics and pandemics, is thought to provide a hugely effective strategy to control the swine flu epidemic.

The Department of Health estimate they will have enough vaccine for half the population by the end of the year.

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Internet surfing: reduce dementia in the elderly?

Neuroscience and human behaviour experts at the University of California, Los Angeles (UCLA) have discovered that for older people with minimal experience, performing internet searches for even a short period of time can boost brain activity patterns potentially slowing or even reversing the age-related declines that can end in dementia.

Using brain scans, the researchers compared the effects of mind stimulation between reading and internet use. Mind stimulation was stronger using the internet and also the effects continued long after an internet session had ended. Professor Small hailed this as their most striking find saying “internet searching appears to engage a greater extent of neural circuitry that is not activated during reading.” Teena Moody, a UCLA researcher said that internet searching challenges the brain more than reading because people need to perform several tasks at once.

Professor Gary Small and his colleagues carried the study out on 24 men and women aged between 55 and 78. Half of them had used the internet a lot; the others had little experience.

The research took place over a two week period involving an initial scan prior to internet activity. Participants then used the internet at home for one-hour periods a day, at least seven times during the fortnight. The second brain scan was carried out while searching the internet.

Professor Small and his colleagues found the impacts immediate. The activated areas from the first scan; controlling language, reading, memory and vision, had spread to include the frontal gyrus and inferior frontal gyrus, areas known to be important in working memory and decision-making.

It has long been known that brain functions and abilities change in people as they age. In Britain, around 700,000 people suffer from dementia, a condition which severely impairs function when so much of the brain has died.

Teena Moody said that “searching online may be a simple form of brain exercise that might be employed to enhance cognition in older adults.”

Small and Moody’s belief is on the basis that brains are similar to muscles: the more they are exercised, the healthier they become. Other neuroscientists support the idea of exercising the brain but question the benefit of spending too much time on the internet.

The research was presented at the annual meeting of the Society for Neuroscience in Chicago.

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Doctors warned against treating friends and family

According to the Medical Defence Union, Doctors are putting their livelihoods at risk by treating friends and family.

Most Doctors can recall an occasion where a friend or family member were seeking reassurance or advice, but without accessing their medical records -how can you be certain of their history? Would you feel comfortable asking someone you know so well if they had suicidal thoughts or took the contraceptive pill? It’s easy to assume current medication, but would all the information you need be volunteered?

Judgement can be clouded so easily by patient relationship and the MDU advice: if you need medical treatment, please don’t be tempted to keep it in the family. It’s almost always in patients’ own interests for their own GPs to be responsible for their medical care to ensure clinical objectivity and continuity of care.

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Womb Transplant by 2011

British scientists have established how to transplant a womb with a regular blood supply so it will last long enough to carry a pregnancy.

The breakthrough could offer hope to childless couples and offer an alternative to surrogacy or adoption. Following conception by IVF, the womb would stay in place only for the duration of the birth. Following delivery through a caesarean section it would then be removed and the patient taken off anti-infection drugs.

The charity Uterine Transplant UK is struggling to find £250,000 following grant denial from medical research bodies and scepticism from critics requiring more research. Richard Smith, consultant gynaecological surgeon at London’s Hammersmith Hospital is confident if funds can be raised, a successful transplant could be done in two years.

Successful research has been conducted at the Royal Veterinary College in London using donor rabbits. The next step is to assess it on larger animals.

An attempt in Saudi Arabia in 2000 on a human womb transplant failed after it was rejected after three months. It was thought by Mr Smith that the blood vessels were not connected properly.

Experts now believe they have solved a number of issues and have “cracked the crux of how to carry out a successful graft”.

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NHS to outlaw age discrimination

Following a review of the treatment of older people in the NHS which provides shocking new evidence that ageism is rife within the NHS, Health Secretary Andy Burnham is due to announce the outlaw of age discrimination in the NHS and social care from 2012 - the same time as the general age discrimination law comes into force.

A poll found almost half of doctors who cared for older people believed the NHS are “institutionally ageist”. Alarmingly as many as seven out of ten specialists say the elderly are more likely to struggle to get conditions properly diagnosed than younger patients.

Researchers found that the younger stroke patient is five times more likely to receive an MRI scan to check for bleeding in the brain than the elder patient. The over-65s lost out on mental health services, with research suggesting two-thirds of those with dementia are never diagnosed, with symptoms being dismissed as consequence of old age – this was also the thought process in some easily identifiable conditions. In other cases elderly patients miss out on heart treatments such as clot-busting drugs.

Mr Burnham said in a press interview that people in the NHS don’t set out to make hard and fast rules that lead to older people getting inferior care. It was also said that some NHS services should be exempt from the ban; those that are being targeted at particular age groups, i.e. IVF treatment, screening and vaccination programmes. Treatment could also be denied on clinical grounds; if an elderly person is too frail to have safe surgery.

Having NHS age discrimination banned by law means those who believe they are victims will be able to mount challenges in the courts which could prove both time consuming and costly.

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Quality Nursing revealed by New Tool

Under a new Strategic Health Authority Initiative funded by The Department of Health, nurses will be able to compare the quality of patient care against other trusts in England. The new initiative ‘Energise for Excellence in Care’, lead by senior nurses is designed to improve fundamental nursing care through a new tool, and once adapted, is hoped to be available on the NHS Institute for Innovation and Improvement website.

The new tool is based on the ‘acuity/ dependency’ tool which was developed by the Association of UK University Hospitals. It helps categorise patients depending on their conditions (for example ‘stable’ or ‘unstable’) which can then be used to help inform staffing levels, skill mix and workforce development needs. It is hoped to enable nurses to deliver evidence-based care and will include the development of new services where appropriate.

In order to improve quality patient care, indicators are key according to Lord Darzi’s Next Stage Review of the NHS, published summer 2008. In May 2009 the Government published a list of over 200 indicators that could be used to improve services across the NHS.

The Chief Executive David Nicholson will take personal responsibility for the ‘quality, innovation, productivity and prevention’ (or QIPP), also the focus of the DH management board.

Although it is hoped that the ‘Energise for Excellence in Care’ initiative will help the QIPP initiative, it is important to stress it also has wider goals, such as getting nurses to focus on the things that really matter to patients. It is designed to give nurses permission to say what needs to be done and encourage them to reflect on the quality of the care that they are providing.

If nurses are consistently providing high quality care, costs may reduce for the NHS with fewer mistakes and improved morale, particularly as low morale is detrimental to productivity and in this case patients.

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£20 to see the Doctor

The Social Market Foundation claims that forcing patients to pay for appointments would help the NHS cope in times of financial hardship. They state the only way to survive would be to raise taxes, limit demand or work more effectively. Whilst funding is guaranteed until 2011, many are expecting the budget to be frozen or cut after that.

Both the government and doctors are against such a move, one doctor saying: “All patients have a right to free healthcare that is based on their clinical needs, not the size of their bank balance.”

Those who support the idea believe it would make patients think twice about their visit and a small charge could help reduce appointments by about 5%. They also say that children and those receiving tax credits should not be charged and the think-tank was opposed to fees being levied on any form of emergency care.

Would we not be simply privatising healthcare? In many other countries there is no free healthcare but help for those on low wages, so it could work, but what about those with existing conditions like diabetes?

Those who oppose the scheme claim charging for appointments would undermine the doctor patient relationship, stopping some needing care from coming to the surgery and is against the founding principles of the NHS - free healthcare for all.

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Millions wasted on “No Shows”

Statistics show that patients failing to keep hospital appointments are costing the NHS at minimum, a staggering £600 million. That’s enough to run two medium-size hospitals! The figures show that between 2007 and 2008, 6.5 million patients missed appointments costing hospitals £100 per patient in revenue. To compensate anticipated non-attendance, some hospitals are overbooking appointments, with obvious repercussions if 100% attendance occurs.

Young males appear to make up the biggest proportion of those that don’t show up and people aged between 70 and 74 were the most reliable in terms of attending appointments. However it isn’t all doom and gloom, over the past few years the attendance figures have improved slightly in England, Northern Ireland and Wales. In Scotland however, figures have actually increased.

To combat missed appointments, schemes such as text message reminders are being rolled out by the Department of Health. Other initiatives such as the ‘choose and book’ scheme have also been introduced. Whilst some say that missing appointments is unforgivable, Unison back patients in saying they are not to blame when appointments are arranged months in advance.

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Regulator Signals Funding Over-Optimism by Foundation Trusts

Monitor, the regulatory body for Foundation Trusts, has responded to Trust 3-year forecasts saying they are concerned that growth forecasts may well be optimistic, given the tighter funding constraints likely to face the NHS beyond 2011.

The 115 foundation trusts authorised as at 31 March 2009 are forecasting a combined income of £26.2 billion in 2009-10, representing growth of 4.2% on incomes in 2008-09. Future growth forecasts suggest continued growth in revenues after 2009- 10 (2.1% in 2010-11 and 1.6% in 2011-12), with similar growth in costs (1.6% and 1.1%).

Stephen Hay, Monitor’s Chief Operating Officer, commented that Trusts were continually improving the quality of their forecasting and submissions to Monitor but that these represented an over optimistic view given the funding famine the NHS is expected to face over coming years. Consequently, Trusts have been asked to submitted revised ‘downside’ forecasts by the end of September to provide a more pessimistic view.

It will be interesting to see if Foundation Trusts plan internally based on the optimistic or pessimistic view and even more interesting to see how they will approach unexpected shortfalls in revenue if the famine turns out to be at the dryer end of predictions.

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Tortilla Chips Lower Cholesterol

Not usually associated with healthy eating but researchers may have found a way to make tortilla chips help lower your cholesterol, by frying the chips in oil containing a plant extract called phytosterol, part of a group of steroid alcohols that naturally occur in plants. The research was conducted within the US and as such most of the discussion and opinion currently available is on whether the tortilla chips taste as good as normal ones and not on whether there are genuine health benefits from the new snack.

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Lord Darzi to quit as Health Minister

Renowned top surgeon Lord Ara Darzi is to resign from his post as Health Minister. According to Downing Street, the move to step down from his current role in government is “to devote more time to his clinical role and academic research”.

Lord Darzi will officially resign on 21st July, the beginning of the Summer Parliamentary recess, but will continue working as a government advisor in the new role of “health and life sciences ambassador.”

In a statement, Downing Street said the role would involve chairing a new NHS Global Forum to promote the NHS and the UK’s life-sciences industry around the world. Lord Darzi will also advise on health reforms in both the NHS and global public health.

Lord Darzi was appointed a minister in summer 2007 into Gordon Brown’s “government of talents” initiative. He was one of four original outsiders from politics – dubbed “goats” to join the initiative, and is now amongst three out of the four original “goats” to have left, or to announce leaving this year.

Of the original four “goats”, Trade Minister - Lord Digby Jones quit last year and Foreign Office Minister - Lord Malloch-Brown is due to stand down at the end of July. Security Minister - Lord West is the last “goat” standing. Of the fellow “goats” appointed last year, Communication and Broadcasting Minister - Lord Carter, is also due to quit shortly. Also remaining in government is City Minister - Lord Myners. These resignations add to the increasing tally of departures the Labour party has seen this year.

Last June Lord Darzi published High Quality Care for All, after leading a year-long major review on the NHS. This report can be found on the Department of Health website
http://www.dh.gov.uk/en/Healthcare/Highqualitycareforall/DH_095237 .

After mixed responses from fellow healthcare professionals for the role Lord Darzi played within the NHS as Healthcare Minister, Gordon Brown dismissed criticism by releasing a statement from Downing Street, thanking Lord Darzi for an “outstanding contribution” as a health minister. Respectfully, Lord Darzi also paid tribute to Labour’s support in the health service.

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Author: Sarah E. Coyne, BA (Hons)
Medicology Ltd

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