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| Tuesday, 18 July 2006 09:48 | | BNN: British Nursing News Online · www.bnn-online.co.uk
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The use of the drug donepezil for Alzheimer's disease is to be limited by the NHS, although it has been shown to slow down shrinking of the brain.
In a study, the drug donepezil did more than relieve symptoms in patients with mild mental impairment - it also had an effect on the size of the brain. But under draft proposals from the National Institute for Health and Clinical Excellence (NICE), it could be limited to those with moderate Alzheimer's and not available to those with milder symptoms.
In Scotland, the Scottish Intercollegiate Guidelines Network recommends using the drugs at all stages of illness. But there are fears that once the NICE guidelines are finalised, they will also be adopted in Scotland and patients will no longer have access to them.
The latest study used MRI scans to measure brain shrinkage in 131 patients with mild cognitive impairment - some were given donepezil and others a dummy drug.
The study found that patients who were carriers of certain genes linked to cholesterol metabolism, the use of the drug resulted in slower shrinking of the hippocampus, the part of the brain that is the key to memory.
Dr Clifford Jack, of the Mayo Clinic in the United States, said: "Our study results seem to imply that donepezil does more than provide symptom relief - it has an effect on a measure of brain health”.
Kate Fearnley, the policy director of Alzheimer Scotland, said: "This research is further evidence of why NICE's recommendation to delay treatment until people have moderate Alzheimer's is fundamentally flawed.
"Although it's a small study, it is in tune with other research which shows the brain changes of Alzheimer's disease may start years before diagnosis”.
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| Tuesday, 18 July 2006 09:37 | | BNN: British Nursing News Online · www.bnn-online.co.uk
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Researchers from Stanford University School of Medicine in California have developed a "magic wand" to stop surgeons leaving foreign objects inside their patients.
Previous research has suggested that one in 10,000 surgical procedures end with something being wrongly left inside the patient. In two-thirds of cases these were surgical sponges.
It is a problem which could lead to serious infection and death. Now researchers have developed a handheld wand which scans a patient's body before they are sewn up. It works by detecting surgical sponges which have been tagged with radiofrequency ID chips.
The researchers tested the battery-powered device on eight patients. They found that the wand was able to find the tagged sponges in less than three seconds.
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| Tuesday, 18 July 2006 09:02 | | BNN: British Nursing News Online · www.bnn-online.co.uk
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German researchers from Heidelberg University have found that even if you only start exercising later in life, it can still dramatically reduce the chance of developing heart disease.
Their study published in the medical journal Heart shows that people who wait until their 40s to take up regular physical activity are 55 per cent less likely to be diagnosed with heart disease than if they remain lazy all their lives.
The researchers compared 312 adults between the ages of 40 and 68 who had confirmed coronary artery disease and 479 volunteers matched for age and sex.
Each participant was interviewed about their level of physical activity in early adulthood, classified as the period between 20 and 39, and in late adulthood, defined as the period after the age of 40.
Unsurprisingly, known risk factors for coronary heart disease, including smoking, diabetes, and high blood pressure tended to be more common among those with confirmed disease.
Around half of those with heart disease and seven out of 10 of the healthy volunteers said that they had been moderately or very physically active in younger and older adulthood.
But around one in 10 of those with confirmed disease and around one in 20 of the healthy volunteers confessed to having enjoyed a lifetime of physical inactivity.
Those who had been active all their lives had the lowest risks. They were around 60 per cent less likely to be diagnosed with coronary heart disease.
But those who became very physically active after the age of 40 were around 55 per cent less likely to be diagnosed with heart disease than those who had embraced inactivity all their lives.
The researchers conclude that while optimal health is likely to be enjoyed by those who exercise all their lives, it is not too late to start. Regular exercise, even if started in older life, still confers many benefits and substantially cuts the risk of heart disease.
Dr Dietrich Rothenbacher, who led the research team, said: "Our results suggest that a more active physical activity pattern is clearly associated with a reduced risk of coronary heart disease.
"We also concluded that changing from a sedentary to a more physically active lifestyle, even in later adulthood, may strongly decrease coronary heart disease”.
Only around a third of men and a fifth of women in England follow government guidelines which recommend 30 minutes of moderate physical activity, such as brisk walking, most days of the week.
Alison Shaw, from the British Heart Foundation, said: "This research suggests that being more physically active throughout your life is associated with a reduced risk of coronary heart disease.
"The earlier you adopt a more physically active lifestyle, the bigger the rewards will be on your heart, helping to reduce your risk in later life. So don't wait until you reach 40 to get active.
"The heart, like all muscles, requires regular physical activity to ensure it functions well.
"We recommend that everyone does 30 minutes of moderate physical activity at least five days a week. You are never too old to start being active.
"But people who are unaccustomed to physical activity and not sure of what activity is right for them should discuss it with their GP”.
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| Tuesday, 18 July 2006 08:46 | | BNN: British Nursing News Online · www.bnn-online.co.uk
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A Swedish study that is featured in the British Journal of Sports Medicine, have found that top footballers are likely to sustain the same injuries season after season.
The study, by Linkoping University, found that suffering a hamstring, groin or knee joint injury almost tripled a player's chances of an identical injury the following season.
The researchers examined reports involving 197 players from 12 top Swedish football teams.
They looked at rates of injury over two consecutive seasons in 2001 and 2002.
They found that older players tended to sustain hamstring injuries more than once; there was no overall association between age and the likelihood of an injury being repeated.
Instead, they believe that repeat injuries are more likely to be the result of risk taking behaviour and psychological factors - if a player makes a mistake once, it might be likely that he will make the same mistake again.
In addition, certain injuries may also weaken a muscle or joint, leaving it vulnerable.
John Brewer, director of the Lucozade Sport Science Academy, said one of the biggest problems faced by top players was limited time for rest, recovery and rehabilitation from injury.
"With clubs and their managers under increasing pressure to deliver results, players know that an injury not only affects the performance of their team - it also means they aren't playing and in many cases their wage packet could also suffer.
"As a consequence, an inadequate amount of time is spent doing the basic strength and conditioning work that is needed to build up weakened muscle, tendon and joint strength, which are an essential part of the recovery process.
"If this doesn't happen, when a player resumes competitive matches, although the injury might have healed, the infrastructure of tendons, ligaments and muscles may not be back to full strength, so the chance of a similar or related injury re-occurring is greatly increased”.
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| Tuesday, 18 July 2006 08:30 | | BNN: British Nursing News Online · www.bnn-online.co.uk
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Campaigners calling for more support for breastfeeding mothers are to lobby Westminster.
The campaigners are to demonstrate outside the Department of Health in Whitehall, followed by the presentation of a petition to Downing Street.
The campaigners are fighting for a national breastfeeding strategy overseen by a national infant feeding coordinator.
They also want a new law to protect a woman's right to breastfeed in public in England, as this law already exists in Scotland.
The campaign is backed by organisations such as the National Childbirth Trust (NCT), the Royal College of Midwives, and the Community Practitioners and Health Visitors Association.
Supporters say there is clear evidence that a comprehensive national breastfeeding strategy would help to raise rates of breastfeeding.
Rosie Dodds, of the NCT, said: "We need more support for breastfeeding mothers in order for them to feel comfortable and able to breastfeed for as long as they want and where they want”.
A Department of Health spokesperson said the Government was committed to promoting breastfeeding as the best form of nutrition for infants.
The aim was to increase breastfeeding rates by two percentage points every year, with a specific focus on women from disadvantaged groups.
"We are collecting data through the National Infant Feeding Survey 2005 on women's experiences of breastfeeding in public.
"We will keep the need for legislation under review in light of this evidence and the Scottish experience”.
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| Tuesday, 18 July 2006 08:12 | | BNN: British Nursing News Online · www.bnn-online.co.uk
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Bishop Auckland General Hospital has apologised after Derek Atkinson, 56, from County Durham, who suffered a burnt toe, ended up having his lower leg amputated.
Derek, who has diabetes, burned his big toe on a hot-water bottle in 2001. He said he had seen a consultant at the hospital five times for treatment.
After two weeks the former teacher was in so much pain that he called his GP, who diagnosed gangrene. The big toe on his left foot was removed and days later his left leg was amputated below the knee.
Mr Atkinson told the Northern Echo: "I saw the consultant five times but all he seemed to do was take swabs, give me antibiotics, bandage it and rebandage it”.
A report from the independent parliamentary and health service ombudsman criticised the care Mr Atkinson received. A spokesman for the Co Durham and Darlington Acute Hospitals NHS trust said: "We have received the ombudsman's report and have written to Mr Atkinson to apologise. We have introduced new guidelines for the management of diabetic patients with foot problems in our accident and emergency departments.
"We believe that these greatly reduce the chance of a similar problem occurring”.
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| Monday, 17 July 2006 10:09 | | BNN: British Nursing News Online · www.bnn-online.co.uk
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Researchers from the Mayo Clinic in America claim that weight loss in women may be an early sign of impending dementia.
In a study of over 1,000 people, women who later developed dementia had a drop in weight for as long as ten years before being diagnosed with Alzheimer's or other degenerative brain conditions.
Dr David Knopman, who led the study, said: "We discovered the weight of those women who developed dementia was drifting downward many years before the onset of symptoms.
"This illustrates changes that occur before the memory loss and mental decline in dementia. We believe that the brain disease began to interfere somehow with maintenance of body weight, long before it affected memory and thinking”.
The UK authors of the study, Dr Robert Stewart and colleagues from the Institute of Psychiatry, London, said: "An important consideration arising from research in this area is the extent to which weight loss may be prevented or minimised in dementia.
"Poor nutrition and frailty frequently complicate later stages of dementia, causing falls, poor wound healing, and increased physical dependence”.
Past studies have suggested that dietary interventions may prevent weight loss in patients Alzheimer's disease and may delay cognitive decline and mortality.
Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: "These findings need to be taking further urgently as they may reveal how dementia develops and therefore provide routes to the new treatments we so desperately need."
She added: "The difference in men and women suggested by this latest research suggests it could be linked to post-menopausal hormone changes.
"This is interesting as low oestrogen levels in women have been shown to increase the risk of dementia”.
Dr Susanne Sorensen, of the Alzheimer's Society, said: "The observed weight loss is interesting as it could indicate the part of the brain responsible for weight loss is also one of the first to be damaged by the disease.
"Further research is now needed to identify what causes this weight loss”.
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| Monday, 17 July 2006 09:51 | | BNN: British Nursing News Online · www.bnn-online.co.uk
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Italian cardiologists from the University of Pavia, suggest that all babies should have an ECG heart scan in their first month of life to check for life-threatening problems.
Writing in the European Heart Journal they claim that routine ECG screening could save up to 250 lives a year in EU countries.
Professor Peter Schwartz and colleagues from the university estimate that by screening, early deaths from long QT syndrome would be cut from 13.5% to 3.2% - saving 23 lives a year in Italy alone.
Early treatment of long QT syndrome would also prevent some deaths that are currently misclassified as sudden infant death syndrome (SIDS).
In the study, ECG screening also picked up two other life-threatening heart conditions in infants, known collectively as congenital heart diseases, which had been missed by other routine medical checks.
Professor Schwartz said: "Our study clearly demonstrates that neonatal ECG screening is highly cost-effective and that a significant number of lives can be saved...for an objectively low cost”.
His team estimates that the cost per year-of-life saved by identifying and treating long QT syndrome would be about 11,740 euros. For saving one entire life of 70 years it would be about 820,000 euros.
Professor Schwartz said: "The time is ripe for those involved in the administration of public health to consider the implementation by the National Health Services of such a programme”.
However, a Department of Health spokesman said: "The UK National Screening Committee has looked specifically at screening children and young adults for abnormal heart conditions and has concluded there is not enough current evidence to support this.
"The NSC will keep this situation under review, taking new evidence into account - including the recent study from Italy”.
Among the 45,000 babies in the Italian study, screening ECGs performed between 15 and 25 days detected potential long QT syndrome in almost one in 1,000. In more than 50% of these infants the researchers identified gene mutations known to be linked with long QT syndrome.
Steve Cox, deputy chief executive of Cardiac Risk in the Young (CRY) said: "This new study is a very encouraging step in our fight to prevent eight needless young deaths every week.
"It shows that neonatal screening is highly cost effective with a significant number of lives saved for an objectively low cost."
However, CRY believes screening should be carried out after puberty.
"Although neonatal screening is clearly important, CRY recommends ECG screening for all young people after puberty when the majority of cardiac conditions that can cause sudden cardiac death can be identified”.
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| Monday, 17 July 2006 09:34 | | BNN: British Nursing News Online · www.bnn-online.co.uk
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Reform an independent, non-party think tank whose mission is to set out a better way to deliver public services and economic prosperity, claims that the NHS wastes cash on big hospital building projects while freezing spending on small schemes.
The Reform think-tank said the reliance on private finance initiative (PFI) projects - more than £18bn is earmarked up to 2014 - was misguided.
The centre-right group said smaller health centres should be funded, but capital budgets were not being spent.
The Government said all PFIs - built using private cash, but paid for over time by the NHS - were being reviewed.
Report author Nick Bosanquet said NHS trusts were being paralysed by the fear of the deficits, which was depriving the health service of the kind of spending it needed.
"Large hospital buildings schemes are only appropriate in certain situations.
"In effect the NHS should move to a system which could fund investment of various sizes from £5m to £30m”.
He even suggested the NHS could rent property as it was "unnecessary and inefficient for the NHS to own so much capital" and added it should be left to local managers to identify more manageable schemes in the future.
Andrew Lloyd-Kendall, policy manager at the NHS Confederation, said the NHS needed to think very carefully about whether PFI builds were needed.
"PFI is a very important tool for bringing hospital facilities up to date. Although the direction of travel is increasingly towards care in community settings there is still a need for hospitals”.
And Paul Miller, chairman of the British Medical Association's consultants committee, added: "We have been asking for a while if PFI is necessary, I am not convinced on the whole they are”.
But a Department of Health spokesman said all PFI schemes were being reappraised to see if they offered "value for money" and were "needed" in the changing climate.
Health Minister Andy Burnham said: "We have asked all trusts taking forward a major PFI scheme to undertake a review to ensure every penny of extra investment in new NHS hospitals is spent wisely and options taken forward locally are in patients' best long-term interests”.
He also pointed out money was being invested in primary care facilities through the LIFT scheme - the equivalent of PFI for community services.
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| Monday, 17 July 2006 08:58 | | BNN: British Nursing News Online · www.bnn-online.co.uk
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A report by The Public Service Ombudsman for Wales, has revealed that three patients (known as A, B, C,) suffered heart and breathing problems during minor surgery after being given an unlicensed drug preparation.
The three men underwent nasal surgery at Ysbyty Gwynedd hospital. Each of the procedure was described as routine minor operations and all three patients expected to leave hospital that same day.
All three patients, in preparation for the operation were administered a drug preparation which included cocaine and was known as Moffett’s Solution. Immediately after her operation the first patient experienced severe respiratory and cardiac problems.
The second patient also suffered similar problems which required his transfer to intensive care. The third patient also experienced similar albeit less severe problems.
A number of other patients who also underwent surgery on the same day in the same theatre using the same anaesthetic parameters but without being administered Moffett’s solution; these patients did not experience any adverse reactions.
The Public Service Ombudsman upheld complaints by all three patients about the problems in April 2003.
North West Wales NHS Trust said it was taking professional advice and would discuss the report with the ombudsman.
The ombudsman criticised the response by the North West Wales NHS Trust, which runs Ysbyty Gwynedd, which did not provide a formal response to the patients' complaints until November 2003.
Despite further representations from two patients, the trust remained unable to provide them with an explanation for their reactions.
Dr Rick Greville, director of the Association of British Pharmaceutical Industries, told BBC Wales it was not unknown for unlicensed drugs to be used to treat patients.
"The responsibility of usage of medicines sits with the doctor so if the doctor is sufficiently experienced with medicines that aren't licensed for that type of patient, the medic concerned would perhaps prescribe that medicine," he said.
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