Given the time of year the BBC health page looks to year the ahead this week and I thought I would do the same. So here is a list of three things (all hyperlinked) to look out for:
1.) The report of the public enquiry into the treatments of patients at Stafford Hospital and the trust involved. Preliminary data suggest that between 2005 and 2008 four hundred patients died unnecessarily because of poor care. Even more extreme is the data suggesting that thirsty patients had to resort to drinking from vases and receptionists were left to assess patients in A&E. What will the outcome of the enquiry be, will legislation be put in place to stop such mismanagement happening again?
2.) Public health initiatives to tackle unhealthy habits, for example will banning the display of tobacco products in shops in England occur and later be followed by the introduction of plain packaging for cigarettes? Australia are the only country to have taken this step so far.
-- A minimum price for alcohol, 45p/unit? Before the decision is made campaigns are taking place to increase the suggested price to 50p/unit as agreed in Scotland already as research suggests this relatively small increase in price can save a more significant number of lives.
3.) 1st April 2013: the NHS Commissioning Board will take over the day-day running of the health service (some of their targets can be seen in a previous post) and the majority of the budget will come under the control of GPs. Although these structures have been operating in the shadows for sometime next year they will be properly introduced. Will the transition go unnoticed with small changes here and there over time or will significant changes take place immediately?
To conclude, keep your eyes peeled and Happy New Year!
Monday 31 December 2012
Monday 24 December 2012
Radiotherapy court case
A very brief post given the time of year, and consequently the travelling and present exchanging that is going on! Despite this I felt I could not ignore the recent court case involving seven year old Neon Roberts.
The case is unusual for a number of reasons. The fact that Neon's mother is refusing treatment for her son itself but also the fact that the identity of the boy has been revealed. Under normal circumstances names would not be given in order to protect the identity of the youngsters involved. However in this particular case the mother went into hiding which was delaying both the court case and important medical treatment so the police felt it was necessary to release names and photos to try and speed up the relocating process!
Neon had previously undergone two operations to remove a cancerous brain tumour and nodule before the most recent hearing however his mother did not want him to have radiotherapy. Her reasoning for this was the potential side effects of the treatment including lowered IQ, infertility and shorter life span. Neon's father (who is separated from the mother) had agreed to his son having radiotherapy.
Perhaps there are alternatives that could be considered? If this was the case then both parties would have their needs met, Neon would receive treatment but not radiotherapy so his mothers fears would be put at ease. However the medical experts involved say there are no other realistic alternatives available, nothing has undergone rigorous clinical trials and shown similar positive outcomes.
If Neon were to receive radiotherapy what would his prognosis be? Without further treatment there is a very strong chance that Neon will die. By contrast the survival rate for children with radiotherapy is between 80%-86%. As such the stressful treatment would not be an unnecessary 'gamble', there is a strong chance the treatment will work for Neon.
It was both of these reasons as well as the risk-benefit balance being strongly in favour of treatment that the court ruled against the mothers wishes. Neon is to undergo radiotherapy to try and prevent the cancer from spreading and will live with his father for the duration of the treatment.
Was the outcome of the trial ever in doubt, could the court of granted the mothers appeal? Probably not. Before reaching such decisions I think a number of things should be/are considered: the prognosis of the patient, availability of alternative treatments, the reasoning of the patient/relative and finally the capacity of the person in question to make such a decision. Cases involving children are particularly tricky as the child may be too young to give consent or lack the capacity to give consent. What do you think of the situation?
Finally it's all very well discussing the situation however I/we must not forget about how difficult these times must be for Neon's mother, having a child whom you love dearly suffer from a life threatening condition yet the only potential solution is aggressive and invasive treatment.
Wednesday 19 December 2012
Proposed changes to the NHS
'Everyone counts: Planning for patients 2013/2014' is the title of a document published by the NHS Commissioning Board yesterday outlining the incentives that will be used to improve NHS services from April 2013, the first year of the new NHS, where improvement will be driven by clinical commissioners.
The document includes a clear set of outcomes against which to measure such improvements and outlines five offers:
1. Move towards a seven-day a week working for routine NHS services
2. Greater transparency and choice for patients
3. More patient participation
4. Better data to support the drive to improve services
5. Higher standards and safer care
I will now look at points one and two in more detail as these points in particular featured in the news over the weekend.
The idea of a seven day service follows research which suggests patients are more likely to die if they are admitted to hospital over the weekend. In fact the study showed that patients in England were 16% more likely to die if they were admitted on a Sunday rather than mid-week.
Staffing - in particular the absence of senior doctors - has been highlighted as a key reason for this.
Although such a scheme would be ideal and may be successful there are obvious obstacles that must be overcome, for example a reluctance to work on the weekend due to family commitments. What incentives or schemes could there be to try and overcome this reluctance? Bearing in mind the NHS is trying to save money whenever possible so lucrative salaries are probably not the answer... Not only are there obstacles but solutions that work for one speciality may not work for another!
Secondly the greater transparency and choice for patients, for example the provision of surgeons' data. Such data on heart surgeons is already available but the aim is to enable access to data belonging to a number of other specialities for example vascular and orthopaedic surgeons.
As well as enhancing patient choice the data would allow surgeons to compare "performance" and consequently this might lead to competition and an incentive or pressure to improve performance.
The primary concern amongst surgeons and other medical professionals with releasing this data is that it may give a misleading impression and may be misinterpreted. For example surgeons performing more difficult, high risk, complex surgery may look to be performing worse and labelled as "bad" surgeons when in fact they are the best surgeons but the nature of their work is extremely high risk.
To conclude Sir David Nicholson, the chief executive of the NHS Commissioning Board said the following about the proposed changes: “At the heart of our approach is local control over decision making. We want to put power in the hands of clinicians who know their patients best. We want to give them the money, information and tools to do the job. And we want the public to have the information they need to make choices and participate fully in the development of their health services.”
The document includes a clear set of outcomes against which to measure such improvements and outlines five offers:
1. Move towards a seven-day a week working for routine NHS services
2. Greater transparency and choice for patients
3. More patient participation
4. Better data to support the drive to improve services
5. Higher standards and safer care
I will now look at points one and two in more detail as these points in particular featured in the news over the weekend.
The idea of a seven day service follows research which suggests patients are more likely to die if they are admitted to hospital over the weekend. In fact the study showed that patients in England were 16% more likely to die if they were admitted on a Sunday rather than mid-week.
Staffing - in particular the absence of senior doctors - has been highlighted as a key reason for this.
Although such a scheme would be ideal and may be successful there are obvious obstacles that must be overcome, for example a reluctance to work on the weekend due to family commitments. What incentives or schemes could there be to try and overcome this reluctance? Bearing in mind the NHS is trying to save money whenever possible so lucrative salaries are probably not the answer... Not only are there obstacles but solutions that work for one speciality may not work for another!
Secondly the greater transparency and choice for patients, for example the provision of surgeons' data. Such data on heart surgeons is already available but the aim is to enable access to data belonging to a number of other specialities for example vascular and orthopaedic surgeons.
As well as enhancing patient choice the data would allow surgeons to compare "performance" and consequently this might lead to competition and an incentive or pressure to improve performance.
The primary concern amongst surgeons and other medical professionals with releasing this data is that it may give a misleading impression and may be misinterpreted. For example surgeons performing more difficult, high risk, complex surgery may look to be performing worse and labelled as "bad" surgeons when in fact they are the best surgeons but the nature of their work is extremely high risk.
To conclude Sir David Nicholson, the chief executive of the NHS Commissioning Board said the following about the proposed changes: “At the heart of our approach is local control over decision making. We want to put power in the hands of clinicians who know their patients best. We want to give them the money, information and tools to do the job. And we want the public to have the information they need to make choices and participate fully in the development of their health services.”
Tuesday 11 December 2012
ENCODE Project
The Encyclopedia of DNA Elements (ENCODE) project is a research project involving a number of organisations from around the world. The project is looking into the entirety of the human genome, it began in 2003 and recently (September 2012) some very important results were published. The results featured in major journals such as 'Nature' - take a look if you can get hold of them!
The areas of the human genome that do not code for protein (98% of the genome) were previously considered to be regions of "junk DNA" with no specific purpose however this project has shown that these non-coding regions are in fact functional and play a very important role. Their primary role is to control gene expression, something I picture as on/off switches.
It is thought that many of these expression regions could be causally linked to disease. Previous research showing similarities or mutations in these non-coding regions may have been ignored because the regions were believed to contain "junk DNA" - if this is the case much of this research will have to be reconsidered and reinterpreted.
What about the future? These recent findings are only an initial exploration of the non-coding regions of the genome and further research will have to take place. This research will focus on trying to find true causal genetic links and to do so will need to consider a wide number of cell types.
Continuing with the topic of genetics, an article on the BBC today describes a plan to sequence the entire human genome in up to 100,000 patients with cancer and other rare diseases. The article does not mention ENCODE but perhaps the decision has come about following the research project?
The Prime Minister has set aside £100m for the sequencing. The ultimate aim is to give a better understanding of a patients genetic make up and how it differs with disease. This will hopefully then lead to better targeting of medicines in the treatment or prevention of disease. Currently there are tests for diseases caused by a single gene however much less is known about diseases involving complex relationships between genes and such relationships may even be influenced by lifestyle/the environment. It is understanding and targeting these relationships that will be a major challenge for geneticists and doctors over the coming years!
(Source: BBC Health)
The areas of the human genome that do not code for protein (98% of the genome) were previously considered to be regions of "junk DNA" with no specific purpose however this project has shown that these non-coding regions are in fact functional and play a very important role. Their primary role is to control gene expression, something I picture as on/off switches.
It is thought that many of these expression regions could be causally linked to disease. Previous research showing similarities or mutations in these non-coding regions may have been ignored because the regions were believed to contain "junk DNA" - if this is the case much of this research will have to be reconsidered and reinterpreted.
What about the future? These recent findings are only an initial exploration of the non-coding regions of the genome and further research will have to take place. This research will focus on trying to find true causal genetic links and to do so will need to consider a wide number of cell types.
Continuing with the topic of genetics, an article on the BBC today describes a plan to sequence the entire human genome in up to 100,000 patients with cancer and other rare diseases. The article does not mention ENCODE but perhaps the decision has come about following the research project?
The Prime Minister has set aside £100m for the sequencing. The ultimate aim is to give a better understanding of a patients genetic make up and how it differs with disease. This will hopefully then lead to better targeting of medicines in the treatment or prevention of disease. Currently there are tests for diseases caused by a single gene however much less is known about diseases involving complex relationships between genes and such relationships may even be influenced by lifestyle/the environment. It is understanding and targeting these relationships that will be a major challenge for geneticists and doctors over the coming years!
(Source: BBC Health)
Tuesday 4 December 2012
Organ donation
In recent weeks/months the Welsh government have proposed an "opt-out" organ donation scheme, if passed the scheme would be the first of its kind in the UK and would be likely to start in 2015.
As the name suggests people will be deemed to have consented to becoming organ donors unless they "opt-out" of the organ donation register.
The proposed scheme will leave families with no official "legal veto" against donation by a deceased loved one. However politicians stress that families will be able to stop organs being removed in practice, and such cases will be looked into carefully as they arise.
The scheme would include all those over 18 that have lived in Wales for six months or more.
The current situation where people must die in hospital to be eligible as a donor, even if they are on the register, will stay the same.
Very briefly, of those that die in hospital there are two types of donors, heart beating and non heart beating. Heart beating donors are those that were on ventilation before death, as such the heart continues to pump and blood flows after death keeping vital organs such as the heart itself supplied with oxygen. By contrast non heart beating donors are those that were not on ventilation before death, as a consequence only certain organs can be donated, the kidneys for example.
Most recently the press has questioned whether such a scheme is really necessary? Currently 60% of families of potential donors approached after death by a specialist nurse agree to donation. The scheme in question could in fact have a negative effect, one causing people to feel organ donation is being 'forced' upon them and therefore becoming reluctant to donate and choosing to "opt-out."
So, what alternative solutions are there? Perhaps the government could invest in campaigns aiming to increase awareness about the importance of organ donation instead to try and increase the number of voluntary donors.
What are the reasons for the 'lack of donors'? Why don't more people opt in to organ donation currently? Here are a few potential reasons:
- Confusion and fear due to a lack of explanation regarding the process. For example, will a doctor fight to save me or will they fight less because I am an organ donor?
- How will the doctor know I am dead and what's to stop them rushing into taking my organs?
- What happens after death, might I need my organs for some reason? This is something I certainly cannot answer myself! What do you think?
The reasons behind those willing to donate are perhaps more obvious, for example:
- As an act of kindness which would better and potentially save someones life
- A personal or family experience in which someone received an organ (as an act of thanks) or did not receive an organ (to prevent others going through a similar situation)
Finally the article mentions the importance of speaking to loved ones about your wishes after death, what would you want to happen to your organs if you were to die? If this has been done then families are much less likely to refuse organ donation as they would know what their loved ones wishes were..
(Source: BBC Health)
As the name suggests people will be deemed to have consented to becoming organ donors unless they "opt-out" of the organ donation register.
The proposed scheme will leave families with no official "legal veto" against donation by a deceased loved one. However politicians stress that families will be able to stop organs being removed in practice, and such cases will be looked into carefully as they arise.
The scheme would include all those over 18 that have lived in Wales for six months or more.
The current situation where people must die in hospital to be eligible as a donor, even if they are on the register, will stay the same.
Very briefly, of those that die in hospital there are two types of donors, heart beating and non heart beating. Heart beating donors are those that were on ventilation before death, as such the heart continues to pump and blood flows after death keeping vital organs such as the heart itself supplied with oxygen. By contrast non heart beating donors are those that were not on ventilation before death, as a consequence only certain organs can be donated, the kidneys for example.
Most recently the press has questioned whether such a scheme is really necessary? Currently 60% of families of potential donors approached after death by a specialist nurse agree to donation. The scheme in question could in fact have a negative effect, one causing people to feel organ donation is being 'forced' upon them and therefore becoming reluctant to donate and choosing to "opt-out."
So, what alternative solutions are there? Perhaps the government could invest in campaigns aiming to increase awareness about the importance of organ donation instead to try and increase the number of voluntary donors.
What are the reasons for the 'lack of donors'? Why don't more people opt in to organ donation currently? Here are a few potential reasons:
- Confusion and fear due to a lack of explanation regarding the process. For example, will a doctor fight to save me or will they fight less because I am an organ donor?
- How will the doctor know I am dead and what's to stop them rushing into taking my organs?
- What happens after death, might I need my organs for some reason? This is something I certainly cannot answer myself! What do you think?
The reasons behind those willing to donate are perhaps more obvious, for example:
- As an act of kindness which would better and potentially save someones life
- A personal or family experience in which someone received an organ (as an act of thanks) or did not receive an organ (to prevent others going through a similar situation)
Finally the article mentions the importance of speaking to loved ones about your wishes after death, what would you want to happen to your organs if you were to die? If this has been done then families are much less likely to refuse organ donation as they would know what their loved ones wishes were..
(Source: BBC Health)
Tuesday 27 November 2012
The Liverpool Care Pathway (LCP)
This week I plan write about the LCP,
something which has featured in the news in recent weeks. Its aim is to provide
a sustained quality of care amongst all patients in their last hours/days of life to ensure a peaceful
and comfortable death.
It is described as the “best practice model for care of the dying” and can be used to support patients in care homes and their own homes as well as hospitals.
So, why was it introduced? In the 1990s end-of-life care was somewhat “patchy” for example some hospitals provided excellent care whilst others did not meet the same standards. Areas of particular concern were that firstly patients were often subject to invasive testing/treatment that offered no chance of preventing death and secondly that the patient was caused unnecessary pain and suffering by needlessly prolonging life.
Any medication that is not helpful at this time may be stopped. In addition it may not be appropriate to continue some tests at this time, for example blood tests, blood pressure and temperature monitoring.
Finally patient comfort must be considered, monitoring bed position to prevent bed sores, the potential use of a special mattress and regular mouth care.
2. The diminished need for food and drink.
Such a need could be a physical sign that their condition is not going to improve. The patient may neither want nor need food/drink and decisions about the use of artificial fluids should be made in the patient’s best interests.
3. Religious/spiritual needs.
Discussion with the relative and where possible the patient to ensure that the desires at the time of or after death are met.
As a result of the recent accusations Care and Support Minister Norman Lamb said he would appoint an independent chair to report on the issue. He said,
"It is clear that everyone wants their loved ones' final hours of life to be as pain free and dignified as possible, and the Liverpool Care Pathway is an important part of achieving this aim. However, as we have seen, there have been too many cases where patients were put on the pathway without a proper explanation or their families being involved. This is simply unacceptable.”
"Today I have committed to appoint an independent chair to review how end-of-life care is working and oversee the reviews into the LCP. This will report back to me in the new year." (Source: BBC News)
It is described as the “best practice model for care of the dying” and can be used to support patients in care homes and their own homes as well as hospitals.
So, why was it introduced? In the 1990s end-of-life care was somewhat “patchy” for example some hospitals provided excellent care whilst others did not meet the same standards. Areas of particular concern were that firstly patients were often subject to invasive testing/treatment that offered no chance of preventing death and secondly that the patient was caused unnecessary pain and suffering by needlessly prolonging life.
Information regarding the pathway on
the Marie Curie Palliative Care Institute website is split up into three main areas…
1. Medication/treatment review.Any medication that is not helpful at this time may be stopped. In addition it may not be appropriate to continue some tests at this time, for example blood tests, blood pressure and temperature monitoring.
Finally patient comfort must be considered, monitoring bed position to prevent bed sores, the potential use of a special mattress and regular mouth care.
2. The diminished need for food and drink.
Such a need could be a physical sign that their condition is not going to improve. The patient may neither want nor need food/drink and decisions about the use of artificial fluids should be made in the patient’s best interests.
3. Religious/spiritual needs.
Discussion with the relative and where possible the patient to ensure that the desires at the time of or after death are met.
The pathway has featured in the news
throughout November, it has faced criticism and scrutiny from many newspapers. For some its
use has become controversial, with relatives reportedly claiming it has been
used without consent and others have reported it being used inappropriately to
meet targets.
However the LCP has been standard
practice for a number of years now, so whilst there have been recent allegations
of individual failings within the procedure (mainly due to lack of
communication between those involved), the model of care itself appears to be both appropriate and
humane. As a result of the recent accusations Care and Support Minister Norman Lamb said he would appoint an independent chair to report on the issue. He said,
"It is clear that everyone wants their loved ones' final hours of life to be as pain free and dignified as possible, and the Liverpool Care Pathway is an important part of achieving this aim. However, as we have seen, there have been too many cases where patients were put on the pathway without a proper explanation or their families being involved. This is simply unacceptable.”
"Today I have committed to appoint an independent chair to review how end-of-life care is working and oversee the reviews into the LCP. This will report back to me in the new year." (Source: BBC News)
Tuesday 20 November 2012
Randomised controlled trial showing spinal cord regeneration (in dogs)
A research team in Cambridge recently undertook the first double blind trial (neither the researchers or the pet owners knew which pets were receiving the real treatment) to test a transplant technique involving olfactory ensheathing cells in "real-life" spinal injuries suffered by dogs. Real life in the sense that the dogs were injured spontaneously and accidentally rather than in the controlled environment of a laboratory. The treatment was also given sometime after the injury occurred.
The transplant consisted of olfactory ensheathing cells* being removed from the lining of the nose. These were then grown and expanded for several weeks in the laboratory.
*The only part of the body where nerve fibres continue to grow in adults is the olfactory (smell) system. Olfactory ensheathing cells (OEC) which are found in the back of the nasal cavity surround the receptor neurones that enable us to smell and convey these signals to the brain. These nerve cells need constant replacement which is promoted by the OEC.
It has been thought for some time that OEC may be useful in spinal chord repair and this recent study supports this.
The trial provides "proof of concept", of the 34 dogs involved 23 had OEC transplanted into their injury site - the remainder were injected with a neutral fluid (a placebo). The results were positive, many of the dogs which received transplant cells showed considerable improvement and were able to walk on a treadmill with the support of a harness. As expected no improvement was seen in the control group.
The transplanted cells regenerated nerve fibres across the damaged region of the spinal cord. As a consequence the dogs were able to regain the use of their back legs and more importantly co-ordinate movement with their front limbs.
However these new nerve connections did not occur over the long distances that would be required to connect the brain to the spinal cord, something which would be crucial for human spinal injury patients who had lost sexual function and bowel/bladder control. Given that in a survey of spinal injury patients these two factors were rated higher in importance than improved mobility.
So how significant is this research and what are its possible clinical implications/benefits for the future? Well, Prof. Geoffrey Raisman who discovered olfactory ensheathing cells in 1985 said "this is not a cure for spinal cord injury in humans - that could still be a long way off. But this is the most encouraging advance for some years and is a significant step on the road towards it." Furthermore despite the recovery seen amongst the dogs in the trial, in humans "the much harder range of higher functions lost in spinal cord injury - hand function, bladder function, temperature regulation, for example - are yet more complicated and still a long way away."
(Source: BBC Health News - also click here to see a video of the transformation from immobility to unassisted mobility in one of the dogs)
The transplant consisted of olfactory ensheathing cells* being removed from the lining of the nose. These were then grown and expanded for several weeks in the laboratory.
*The only part of the body where nerve fibres continue to grow in adults is the olfactory (smell) system. Olfactory ensheathing cells (OEC) which are found in the back of the nasal cavity surround the receptor neurones that enable us to smell and convey these signals to the brain. These nerve cells need constant replacement which is promoted by the OEC.
It has been thought for some time that OEC may be useful in spinal chord repair and this recent study supports this.
The trial provides "proof of concept", of the 34 dogs involved 23 had OEC transplanted into their injury site - the remainder were injected with a neutral fluid (a placebo). The results were positive, many of the dogs which received transplant cells showed considerable improvement and were able to walk on a treadmill with the support of a harness. As expected no improvement was seen in the control group.
The transplanted cells regenerated nerve fibres across the damaged region of the spinal cord. As a consequence the dogs were able to regain the use of their back legs and more importantly co-ordinate movement with their front limbs.
However these new nerve connections did not occur over the long distances that would be required to connect the brain to the spinal cord, something which would be crucial for human spinal injury patients who had lost sexual function and bowel/bladder control. Given that in a survey of spinal injury patients these two factors were rated higher in importance than improved mobility.
So how significant is this research and what are its possible clinical implications/benefits for the future? Well, Prof. Geoffrey Raisman who discovered olfactory ensheathing cells in 1985 said "this is not a cure for spinal cord injury in humans - that could still be a long way off. But this is the most encouraging advance for some years and is a significant step on the road towards it." Furthermore despite the recovery seen amongst the dogs in the trial, in humans "the much harder range of higher functions lost in spinal cord injury - hand function, bladder function, temperature regulation, for example - are yet more complicated and still a long way away."
(Source: BBC Health News - also click here to see a video of the transformation from immobility to unassisted mobility in one of the dogs)
Tuesday 13 November 2012
"Vegetative state"
There is a Panorama special on BBC 1 tonight giving an insight into the lives of patients in a vegetative state and the consequent effect on their families.
However there is not complete agreement on the topic of vegetative patients, what does it mean to be "vegetative"?
The group of patients involved in the programme have all suffered from brain injuries, usually through trauma such as a car accident or perhaps another condition such as a stroke or viral infection.
The patients are different to "locked-in patients" whom I have previously written about, those who are paralysed however their brain function is normal and they can often communicate through eye movements. Vegetative patients are different as the brain damage suffered is so severe it leaves them with nothing but core reflexes, ie no brain function. They may be able to move their limbs or eyes but it cannot be due to command or controlled.
The Royal Hospital of Unpredictability (RHN) in London involved in the programme invented a vegetative assessment technique, SMART, which explores all five senses to detect any potential form of cognitive awareness or an ability to communicate.
In addition a fascinating brain scanning technique has been developed by Prof. Adrian Owen and his team which uses functional Magnetic Resonance Imaging (fMRI) to detect hidden awareness amongst patients who may be deemed vegetative by observational assessments.
The technique has recently been used to show hidden awareness in a Canadian patient, Scott Routley, who was believed to have been in a vegetative state for over ten years! Assessments since the car accident twelve years ago (the cause of the brain damage) have shown no signs of awareness or communication until now.
The patterns shown by the scans of brain activity show he is clearing choosing to answer questions. During the research healthy volunteers were asked simple questions and asked to think of the answer for a period of time, before saying it, whilst their brains were scanned. The same questions were then asked to brain damaged, vegetative patients and the images recorded were compared to those of the healthy volunteers and in Scott's case they showed cognitive function and understanding.
Observational assessments of Scott's behaviour since the brain scan continue to suggest he is in a vegetative state. In the future will scans such as the one using fMRI be used in addition to observational assessments to decide if someone is in a vegetative state?
Finally Prof. Adrian Owen said "asking a patient something important to them has been our aim for many years. In future we could ask what we could do improve their quality of life. It could be simple things like the entertainment we provide or the times of day they are washed and fed." (Source:BBC)
However there is not complete agreement on the topic of vegetative patients, what does it mean to be "vegetative"?
The group of patients involved in the programme have all suffered from brain injuries, usually through trauma such as a car accident or perhaps another condition such as a stroke or viral infection.
The patients are different to "locked-in patients" whom I have previously written about, those who are paralysed however their brain function is normal and they can often communicate through eye movements. Vegetative patients are different as the brain damage suffered is so severe it leaves them with nothing but core reflexes, ie no brain function. They may be able to move their limbs or eyes but it cannot be due to command or controlled.
The Royal Hospital of Unpredictability (RHN) in London involved in the programme invented a vegetative assessment technique, SMART, which explores all five senses to detect any potential form of cognitive awareness or an ability to communicate.
In addition a fascinating brain scanning technique has been developed by Prof. Adrian Owen and his team which uses functional Magnetic Resonance Imaging (fMRI) to detect hidden awareness amongst patients who may be deemed vegetative by observational assessments.
The technique has recently been used to show hidden awareness in a Canadian patient, Scott Routley, who was believed to have been in a vegetative state for over ten years! Assessments since the car accident twelve years ago (the cause of the brain damage) have shown no signs of awareness or communication until now.
The patterns shown by the scans of brain activity show he is clearing choosing to answer questions. During the research healthy volunteers were asked simple questions and asked to think of the answer for a period of time, before saying it, whilst their brains were scanned. The same questions were then asked to brain damaged, vegetative patients and the images recorded were compared to those of the healthy volunteers and in Scott's case they showed cognitive function and understanding.
Observational assessments of Scott's behaviour since the brain scan continue to suggest he is in a vegetative state. In the future will scans such as the one using fMRI be used in addition to observational assessments to decide if someone is in a vegetative state?
Finally Prof. Adrian Owen said "asking a patient something important to them has been our aim for many years. In future we could ask what we could do improve their quality of life. It could be simple things like the entertainment we provide or the times of day they are washed and fed." (Source:BBC)
Thursday 8 November 2012
Movember
Firstly I should apologise for my lack of posts recently, the reason for this is that I have been on holiday for the past two weeks! Lucky me! However I am now back at school and into the full swing of things and plan to write a bit about Movember this week, an amusing take on November with a very good cause behind it!
The idea began in Australia in 2003 with Adam Garone and has since evolved into a worldwide fund raising campaign to raise awareness for men's health, particularly prostate cancer. The "Mo" in Movember is Australian slang for moustache and the idea behind the campaign is to begin the month of November clean shaven and grow a stylish moustache to show your support and gain sponsorship for doing so.
Prostate cancer is the most common cancer amongst men and around 36,000 men are diagnosed each year in the UK. The prostate itself is a small gland (about the size of a walnut) located between the penis and the bladder.*
As a consequence symptoms of prostate cancer are usually urinary related and only noticeable when the cancerous tumour has grown large enough to put pressure on the urethra. For example needing to urinate more frequently, difficulty in starting to urinate and weak flow.*
However such symptoms are not a definite indicator of prostate cancer as the prostate gland can get bigger as men get older and press on the urethra causing similar symptoms. This is known as benign prostate disease.*
The diagnosis of prostate cancer is not straight forward but often involves a screening test followed by a biopsy. The levels of prostate-specific antigen (PSA) (a protein produced by the prostate) in the blood can be measured however levels can also increase with age. A patient could also undergo a digital rectal examination (DRE), this is an examination of the rectum which is close to the prostate gland to feel for a hard bumpy area. Finally a biopsy of tissue is taken from the prostate and is studied in the lab for cancerous cells.* (*Source: NHS Choices)
The slogan of the charity is "changing the face of men's health one moustache at a time" - quite literally!
This video on 'Ted Talks' about Movember is REALLY worth watching, its informative but will definitely make you laugh and is given by Adam Garone himself.
The campaign has three main aims: to improve awareness and educate the general public, provide survivor support programmes and fund prostate cancer research. Since it's founding it has become the largest contributor to the Prostate Cancer Foundation and raised over $126 million last year.
The idea began in Australia in 2003 with Adam Garone and has since evolved into a worldwide fund raising campaign to raise awareness for men's health, particularly prostate cancer. The "Mo" in Movember is Australian slang for moustache and the idea behind the campaign is to begin the month of November clean shaven and grow a stylish moustache to show your support and gain sponsorship for doing so.
Prostate cancer is the most common cancer amongst men and around 36,000 men are diagnosed each year in the UK. The prostate itself is a small gland (about the size of a walnut) located between the penis and the bladder.*
As a consequence symptoms of prostate cancer are usually urinary related and only noticeable when the cancerous tumour has grown large enough to put pressure on the urethra. For example needing to urinate more frequently, difficulty in starting to urinate and weak flow.*
However such symptoms are not a definite indicator of prostate cancer as the prostate gland can get bigger as men get older and press on the urethra causing similar symptoms. This is known as benign prostate disease.*
The diagnosis of prostate cancer is not straight forward but often involves a screening test followed by a biopsy. The levels of prostate-specific antigen (PSA) (a protein produced by the prostate) in the blood can be measured however levels can also increase with age. A patient could also undergo a digital rectal examination (DRE), this is an examination of the rectum which is close to the prostate gland to feel for a hard bumpy area. Finally a biopsy of tissue is taken from the prostate and is studied in the lab for cancerous cells.* (*Source: NHS Choices)
The slogan of the charity is "changing the face of men's health one moustache at a time" - quite literally!
This video on 'Ted Talks' about Movember is REALLY worth watching, its informative but will definitely make you laugh and is given by Adam Garone himself.
The campaign has three main aims: to improve awareness and educate the general public, provide survivor support programmes and fund prostate cancer research. Since it's founding it has become the largest contributor to the Prostate Cancer Foundation and raised over $126 million last year.
Tuesday 23 October 2012
Revalidation
The new system of revalidation due to start in December is about addressing "deficiencies" according the the health secretary, Jeremy Hunt.
There are currently no mandatory checks on the performance of individual doctors, however there is the system of registration which is over seen by the General Medical Council (GMC).
If serious complaints are raised about medical practice the GMC begin disciplinary procedures. This system only identifies problems after they occur whereas by contrast revalidation has been designed to try and prevent the problems occurring by regularly monitoring medical practice.
Each NHS organisation will appoint a "responsible officer", such as a medical director, in charge of overseeing the revalidation process.
The revalidation process will be carried out every five years by the GMC using evidence based on annual appraisals and feedback from both patients and colleagues on the medic in question. The "responsible officer" will make a recommendation to the GMC to aid their decision and in the vast majority of cases revalidation will occur. However, minor issues may lead to revalidation being delayed and major issues could lead to revalidation being rejected. In this case the medic would then not be allowed to practice.
In December of this year senior medical leaders will undergo revalidation checks and by April 2016 the "vast majority" of medics should have been checked.
"During piloting and testing of the new system, concerns were raised over the performance of 4.1% of doctors.
In 2.4% of cases the issues were judged to be lower level, such as lateness, in 1% they were medium level, which included problems with behaviour including rudeness to patients, while in 0.7% the problems were serious and would have had an impact on safety" (Source: BBC News)
The change is certainly a significant one, in fact "the biggest change in medical regulation for 150 years since the creation of the GMC." However we will have to wait and see if the new system is an effective one, will it lead to improvements in provision or could it affect patient care? For example the administration and assessments will be very time consuming, time which could be spent on patient care.. But regular checks will help to ensure doctors are providing the service expected of them..
There are currently no mandatory checks on the performance of individual doctors, however there is the system of registration which is over seen by the General Medical Council (GMC).
If serious complaints are raised about medical practice the GMC begin disciplinary procedures. This system only identifies problems after they occur whereas by contrast revalidation has been designed to try and prevent the problems occurring by regularly monitoring medical practice.
Each NHS organisation will appoint a "responsible officer", such as a medical director, in charge of overseeing the revalidation process.
The revalidation process will be carried out every five years by the GMC using evidence based on annual appraisals and feedback from both patients and colleagues on the medic in question. The "responsible officer" will make a recommendation to the GMC to aid their decision and in the vast majority of cases revalidation will occur. However, minor issues may lead to revalidation being delayed and major issues could lead to revalidation being rejected. In this case the medic would then not be allowed to practice.
In December of this year senior medical leaders will undergo revalidation checks and by April 2016 the "vast majority" of medics should have been checked.
"During piloting and testing of the new system, concerns were raised over the performance of 4.1% of doctors.
In 2.4% of cases the issues were judged to be lower level, such as lateness, in 1% they were medium level, which included problems with behaviour including rudeness to patients, while in 0.7% the problems were serious and would have had an impact on safety" (Source: BBC News)
The change is certainly a significant one, in fact "the biggest change in medical regulation for 150 years since the creation of the GMC." However we will have to wait and see if the new system is an effective one, will it lead to improvements in provision or could it affect patient care? For example the administration and assessments will be very time consuming, time which could be spent on patient care.. But regular checks will help to ensure doctors are providing the service expected of them..
Tuesday 16 October 2012
"Smart-e-pants"
Recent preliminary research described in the Telegraph has
shown that “smart-e-pants”, specially designed underwear, may be able to stop patients
developing pressure sores.
Pressure sores form when patients remain stuck in one
position for too long. As a consequence the surrounding skin is compressed and
blood supply is cut off. If the blood supply remains cut off and therefore a lack
of oxygen and nutrient delivery to the tissue occurs for a prolonged period the
tissue will die. This can then lead to open sores developing which can cause
further problems and are at risk to infection. Click here for more information. Particular sore prone areas
include the hips and the coccyx, both of which would be covered by the
underwear.
The underwear is designed to prevent these series of events occurring.
Lined with electrical wiring and with electrodes placed on each cheek tiny
electric currents are released every 10 minutes to stimulate the surrounding
muscles, mimicking fidgeting in an able patient, which prevents sores
developing.
The month long trial involving 33 patients by researchers
from the University Of Calgary, Canada found that none of the patients
developed pressure sores despite all being considered high-risk patients.
The most important factor in preventing pressure sores is
ensuring regular movement throughout the day. Current treatment involves
turning patients over to relieve pressure and the protective padding of
prominent bony areas.
Pressure sores cost the NHS up to £2 billion each year and
affect 500,000 patients in the UK each year. Larger studies are needed to
determine whether or not the underwear could be used as an effective tool in
the prevention of pressure sores. The article suggests that the underwear could
be available to market in three years and could potentially save the NHS time
and money through prevention.
Tuesday 9 October 2012
"Right-to-life" case
This week I am writing about another ethical court case I read about! The case involves a Muslim patient with severe brain damage.
After many weeks the court has now ruled that the hospital trust in question can legally with hold life-saving treatment if his condition deteriorates. The decision was reached largely due to the unanimous medical opinion that resuscitation would not prolong life "in any meaningful way" and it is therefore not in the best interest of the patient to intervene should things deteriorate.
The case is understandably complex, such a decision is something no one would want to hear about a loved one, however there is added complexity in this case. As well as the family's wishes the patient is a Muslim and such an act would go against the Muslim faith. According to the family everything must be done to prolong life "until God takes it away." According to the Quran "Muslims cannot kill, or be complicit in the killing of another, except in the interests of justice."
However the Islamic code of medical ethics states that "..it is the process of life that the doctor aims to maintain and not the process of dying."
Does this mean doctors can stop attempting to prolong a patient's life if there is no hope of a cure?
After many weeks the court has now ruled that the hospital trust in question can legally with hold life-saving treatment if his condition deteriorates. The decision was reached largely due to the unanimous medical opinion that resuscitation would not prolong life "in any meaningful way" and it is therefore not in the best interest of the patient to intervene should things deteriorate.
The case is understandably complex, such a decision is something no one would want to hear about a loved one, however there is added complexity in this case. As well as the family's wishes the patient is a Muslim and such an act would go against the Muslim faith. According to the family everything must be done to prolong life "until God takes it away." According to the Quran "Muslims cannot kill, or be complicit in the killing of another, except in the interests of justice."
However the Islamic code of medical ethics states that "..it is the process of life that the doctor aims to maintain and not the process of dying."
Does this mean doctors can stop attempting to prolong a patient's life if there is no hope of a cure?
Tuesday 2 October 2012
Stoptober
Continuing with the trend, this month, entitled "Stoptober" is a stop-smoking monthly campaign launched in England by the government.
The aim of the campaign is to encourage smokers to stop smoking for 28 days starting on the 1st October, as research has shown that those who can stop smoking for 28 days are five times more likely to stay smoke free!
This is the first time the government has launched a "mass quit attempt" and it will be supported by the media through the use of TV/radio advertising, a daily support messaging service and roadshows around the country. The NHS smoke free website can be found here. It is hoped that the extra support and group effort will help more individuals quit than if they were to try alone. An example of this group effort is the movement of a "Stoptober wheel" up and down the country which people can sign as a pledge to quit.
A representative for Cancer Research UK which is backing the campaign along with the British Heart Foundation said "smoking accounts for one in four cancer deaths and nearly a fifth of all cancer cases". Another telling statistic is that one in two long term smokers will die from a smoking related disease.
As well as the motivation and group support smokers who join the campaign are given free support to help them quit, another incentive to try and quit!
I think the campaign can only be seen as a good thing and the more people it helps the better! In terms of health care the statistics show that smoking causes or contributes to a large number of diseases, many of which cost the NHS time and money. In a sense the campaign is preventative treatment, prevent people acquiring these diseases by helping them to stop smoking. Consequently this will save the NHS time and money in the future.
The aim of the campaign is to encourage smokers to stop smoking for 28 days starting on the 1st October, as research has shown that those who can stop smoking for 28 days are five times more likely to stay smoke free!
This is the first time the government has launched a "mass quit attempt" and it will be supported by the media through the use of TV/radio advertising, a daily support messaging service and roadshows around the country. The NHS smoke free website can be found here. It is hoped that the extra support and group effort will help more individuals quit than if they were to try alone. An example of this group effort is the movement of a "Stoptober wheel" up and down the country which people can sign as a pledge to quit.
A representative for Cancer Research UK which is backing the campaign along with the British Heart Foundation said "smoking accounts for one in four cancer deaths and nearly a fifth of all cancer cases". Another telling statistic is that one in two long term smokers will die from a smoking related disease.
As well as the motivation and group support smokers who join the campaign are given free support to help them quit, another incentive to try and quit!
I think the campaign can only be seen as a good thing and the more people it helps the better! In terms of health care the statistics show that smoking causes or contributes to a large number of diseases, many of which cost the NHS time and money. In a sense the campaign is preventative treatment, prevent people acquiring these diseases by helping them to stop smoking. Consequently this will save the NHS time and money in the future.
Tuesday 25 September 2012
World Alzheimer's Month
September 2012 is the first global "World Alzheimer's Month". Its aim is to challenge and consequently decrease the stigma* associated with dementia and make communities more "dementia friendly" so that many suffers become less isolated. To do this events have been set up all over the world this month!
Dementia is a term used to describe different brain disorders that affect memory, thinking, behaviour and emotion.
To give you an idea of scale there are currently more than 36 million people worldwide living with dementia.
General early symptoms of dementia include; memory loss, difficulty performing familiar tasks, speech difficulties and mood changes.
Although the symptoms can be generalised it must be remembered that everyone is unique and two dementia suffers are very unlikely to experience exactly the same symptoms.
Alzheimer's disease is the most common cause of dementia and therefore the cause which I am going to focus on. There are other causes too, for example vascular disease, where vessels supplying brain cells become narrower or blocked and this can cause these cells to seize functioning and die.
Alzheimer's disease causes nerve cells in particular regions of the brain to die. As a consequence messages cannot be transmitted in the brain, particularly those associated with memory and speech. Not only do nerve cells die but there is also a lack of some important chemicals associated with the transmission of messages. The disease is progressive meaning the damage to nerve cells increases over time causing the symptoms to become more pronounced and severe.
"Tangles" and "plaques" of protein molecules in the damaged areas of the brain can be seen under a microscope. Such images would confirm the diagnosis as Alzheimer's disease.
More detailed information on Alzheimer's disease can be found here!
Age is the greatest risk factor for dementia, it affects "one in fourteen people over the age of 65 and one in six people over the age of 80".
In terms of treatment there is currently no cure. At the moment early diagnosis is very beneficial and drug treatments are used to stabilise some of the symptoms/slow progression.
* "a mark of disgrace associated with a particular circumstance, quality or person" (Oxford English Dictionary)
Dementia is a term used to describe different brain disorders that affect memory, thinking, behaviour and emotion.
To give you an idea of scale there are currently more than 36 million people worldwide living with dementia.
General early symptoms of dementia include; memory loss, difficulty performing familiar tasks, speech difficulties and mood changes.
Although the symptoms can be generalised it must be remembered that everyone is unique and two dementia suffers are very unlikely to experience exactly the same symptoms.
Alzheimer's disease is the most common cause of dementia and therefore the cause which I am going to focus on. There are other causes too, for example vascular disease, where vessels supplying brain cells become narrower or blocked and this can cause these cells to seize functioning and die.
Alzheimer's disease causes nerve cells in particular regions of the brain to die. As a consequence messages cannot be transmitted in the brain, particularly those associated with memory and speech. Not only do nerve cells die but there is also a lack of some important chemicals associated with the transmission of messages. The disease is progressive meaning the damage to nerve cells increases over time causing the symptoms to become more pronounced and severe.
"Tangles" and "plaques" of protein molecules in the damaged areas of the brain can be seen under a microscope. Such images would confirm the diagnosis as Alzheimer's disease.
More detailed information on Alzheimer's disease can be found here!
Age is the greatest risk factor for dementia, it affects "one in fourteen people over the age of 65 and one in six people over the age of 80".
In terms of treatment there is currently no cure. At the moment early diagnosis is very beneficial and drug treatments are used to stabilise some of the symptoms/slow progression.
* "a mark of disgrace associated with a particular circumstance, quality or person" (Oxford English Dictionary)
Wednesday 19 September 2012
'Three people, one baby' consultation begins
The Human Fertilisation Embryology Authority (HFEA) has
launched a public consultation on the ethics of new IVF-based techniques
designed to avoid serious mitochondrial diseases. Unlike other techniques, this
would only benefit a small, select group of couples. However it would enable
these couples to have a healthy child and future generations of the family
would also be free from the genetic fault.
“Around 1 in 200 children are born each year with a form of
mitochondrial disease. Some children have mild or no symptoms but others can be
severely affected and have a shortened life expectancy. Symptoms include muscle
weakness, intestinal disorders and heart disease.”
Mitochondria are passed onto a child from the mother’s egg
only, and not father’s sperm. The basic idea behind the technique is to add a
donors healthy mitochondria to the mix. This can be done in one of two ways, by
using a donor embryo containing healthy mitochondria or a donor egg with
healthy mitochondria.
These two techniques are summarised here on the BBC, take a look because it includes useful diagrams too!
Research
into the area is legal in the UK however it cannot be used in patients;
scientists in Newcastle have created 80 embryos using the technique. A
scientific review released last year concluded that there were no safety
concerns that should prevent the technique being used in couples.
Any child born using the technique would be born with DNA
from three people (as mitochondria contain their own genes in their own DNA),
albeit the amount of donor DNA would be very small. This genetic modification
to the “germ line” would be permanent and passed down from generation to
generation.
It is largely this aspect that raises the ethics and many
questions must be thought about, for example:
- Could the
technique be exploited and modified to create “designer babies?
-How would a
child born through this technique feel? Consequently when should they told?
-What effect would
it have on the parents?
-What is the
status of the female donor?
Finally would you feel differently
about the issue if your child was a sufferer of the disease? The HFEA will now act
as an independent regulator “to seek public views on whether these
techniques should be made available to couples at risk of having an affected
child.”
Tuesday 11 September 2012
Judge rules patient should be force fed
I came across an interesting article whilst reading the student bmj today and thought I would summarise it here.
The patient (unnamed) is described as being a "severely anorexic" 32 year old woman who has had a BMI "between 11 and 12 for the past two years." She was being allowed to die in an end to life care pathway however the judge ruled she should be force fed.
The patient history includes record of serious sexual abuse between the ages of 4-11, unknown to the parents. She told doctors being force fed was like "reliving the abuse."
The judge believed she lacked the capacity to refuse treatment. Her fear of weight gain made her "incapable of weighing the advantages and disadvantages of eating in any meaningful way" and she was in a "drug haze" caused by heavy sedation.
If a person is deemed to lack capacity, as in this instance, the court has to decide what course of action is in his/her best interest.
The patient "did not seek death but above all did not want to be fed" however granting her wishes would ultimately lead to death.
The judge is said to have based their decision on the basis that resources would be provided "in the short, medium and long term" during the treatment and the fact that the patient's views may change in the future as well as the capacity factor.
Despite the judgement an eating disorder specialist put the prognosis of recovery at "10% to 20%"
Tuesday 4 September 2012
Dial 999... and wait?
"Dial 999... and wait?" - The title of the BBC panorama program I watched last night, the program can be found here if you're interested in watching it yourself!
The program investigates the response times of the three emergency services following government public spending cuts.
Are increased wait times putting peoples lives at risk? The program looks at each service in turn and finally the ambulance service, the one which interested me most due to its links with the NHS and my interest in medicine.
NHS budgets are "ring fenced" meaning they are protected/isolated from public spending cuts. As a result of this you would expect that the NHS ambulance service would be exempt from these cuts. However to meet rising costs the service has been asked to make efficiency savings and to do this cuts have had to be made.
For example the use of enhanced clinical triage where clinicians assess each 999 call and determine how quick of a response each call requires and which calls need no response at all (saving ambulance journeys) as they can be dealt with over the phone.
The case study featured in the program describes an 83 year old woman who suffers a serious fall in her home but manages to call 999 from her mobile to ask for assistance. After waiting for an hour, hoping the ambulance would arrive any minute she called her daughter who then came to the house. She too called the ambulance service but was told her mother wasn't a priority case as she was still breathing and not bleeding. When the situation changed and became more serious an ambulance was dispatched and the woman was taken to hospital.
Despite incidences such as this government statistics show that all 12 ambulance trusts achieved the key performance target of reaching 75% of all life-threatening situations within 8 minutes.
However representatives from ambulance trusts hinted that these statistics could be misleading and that 999 calls were being re prioritised in order to meet performance targets. For example "upgrading" a less serious incident to life threatening when an ambulance is in the surrounding area and can therefore reach the scene in or under 8 minutes.
There is no evidence to support such claims but representatives from different trusts are said to have all implied a similar message. If the claims were shown to be true they would obviously be taken very seriously and an investigation would occur.
Ultimately the question is, what will happen in the near future? I imagine there are challenges ahead as more savings will need to be made over the coming years. How will this be done? And will it have a significant, visible effect on wait times for the emergency services?
The program investigates the response times of the three emergency services following government public spending cuts.
Are increased wait times putting peoples lives at risk? The program looks at each service in turn and finally the ambulance service, the one which interested me most due to its links with the NHS and my interest in medicine.
NHS budgets are "ring fenced" meaning they are protected/isolated from public spending cuts. As a result of this you would expect that the NHS ambulance service would be exempt from these cuts. However to meet rising costs the service has been asked to make efficiency savings and to do this cuts have had to be made.
For example the use of enhanced clinical triage where clinicians assess each 999 call and determine how quick of a response each call requires and which calls need no response at all (saving ambulance journeys) as they can be dealt with over the phone.
The case study featured in the program describes an 83 year old woman who suffers a serious fall in her home but manages to call 999 from her mobile to ask for assistance. After waiting for an hour, hoping the ambulance would arrive any minute she called her daughter who then came to the house. She too called the ambulance service but was told her mother wasn't a priority case as she was still breathing and not bleeding. When the situation changed and became more serious an ambulance was dispatched and the woman was taken to hospital.
Despite incidences such as this government statistics show that all 12 ambulance trusts achieved the key performance target of reaching 75% of all life-threatening situations within 8 minutes.
However representatives from ambulance trusts hinted that these statistics could be misleading and that 999 calls were being re prioritised in order to meet performance targets. For example "upgrading" a less serious incident to life threatening when an ambulance is in the surrounding area and can therefore reach the scene in or under 8 minutes.
There is no evidence to support such claims but representatives from different trusts are said to have all implied a similar message. If the claims were shown to be true they would obviously be taken very seriously and an investigation would occur.
Ultimately the question is, what will happen in the near future? I imagine there are challenges ahead as more savings will need to be made over the coming years. How will this be done? And will it have a significant, visible effect on wait times for the emergency services?
Tuesday 28 August 2012
Blood doping
Having already posted about doping a week or two ago following the olympics I thought I would research blood doping following the accusations against Lance Armstrong and this is what I learnt...
Blood doping is the act of increasing the number of red blood cells (rbc) in the bloodstream in order to enhance athletic performance. Consequently haemoglobin (hb) the oxygen transporting molecule is also increased improving an athletes capacity (VO2 Max) and endurance. There are two types of blood doping, Homologous and Autologous doping.
A measure of rbc count is hematocrit, which is the volume percentage of rbc within the blood. This is normally around 45% for men and 40% for women as an average.
Homologous doping involves extracting someones compatible blood, concentrating the rbc, storing them and later transfusing them by injection before exercise. However a chemical test was developed in 2004 to identify anyone guilty of homologous doping, in very simple terms the test examines markers on the surface of blood cells with the ability to determine whether blood from more than one person is present in the athletes circulation.
Hence Autologous doping became more popular, the extraction of ones own blood, concentrating the rbc, storing them and later transfusing them by injection before exercise. The World Anti-Doping Association (WADA) are developing a test to compare the age of blood cells which has not yet reached official testing standard. The test compares the number of 'mature' (erythrocytes) and 'immature' (reticulocytes) rbc. Cells are marked using a fluorescent dye which marks RNA and DNA and automatically counted using laser technology. Erythrocytes have neither RNA or DNA, reticulocytes have a small amount of RNA and lymphocytes (white blood cells which are also present) have a large amount of DNA. The differences in dye concentration can easily be used to distinguish between the cells and there should be standard proportion of 'mature' to 'immature' rbc.
Hormones can also be used to increase rbc count and are often harder to detect. For example erythropoietin (EPO) stimulates the formation of rbc and is used medically as a treatment for anemia (deficiency of rbc). Athletes sometimes abuse this medical drug and use its properties to enhance performance.
Blood doping is the act of increasing the number of red blood cells (rbc) in the bloodstream in order to enhance athletic performance. Consequently haemoglobin (hb) the oxygen transporting molecule is also increased improving an athletes capacity (VO2 Max) and endurance. There are two types of blood doping, Homologous and Autologous doping.
A measure of rbc count is hematocrit, which is the volume percentage of rbc within the blood. This is normally around 45% for men and 40% for women as an average.
Homologous doping involves extracting someones compatible blood, concentrating the rbc, storing them and later transfusing them by injection before exercise. However a chemical test was developed in 2004 to identify anyone guilty of homologous doping, in very simple terms the test examines markers on the surface of blood cells with the ability to determine whether blood from more than one person is present in the athletes circulation.
Hence Autologous doping became more popular, the extraction of ones own blood, concentrating the rbc, storing them and later transfusing them by injection before exercise. The World Anti-Doping Association (WADA) are developing a test to compare the age of blood cells which has not yet reached official testing standard. The test compares the number of 'mature' (erythrocytes) and 'immature' (reticulocytes) rbc. Cells are marked using a fluorescent dye which marks RNA and DNA and automatically counted using laser technology. Erythrocytes have neither RNA or DNA, reticulocytes have a small amount of RNA and lymphocytes (white blood cells which are also present) have a large amount of DNA. The differences in dye concentration can easily be used to distinguish between the cells and there should be standard proportion of 'mature' to 'immature' rbc.
Hormones can also be used to increase rbc count and are often harder to detect. For example erythropoietin (EPO) stimulates the formation of rbc and is used medically as a treatment for anemia (deficiency of rbc). Athletes sometimes abuse this medical drug and use its properties to enhance performance.
Monday 20 August 2012
Tony Nicklinson
For those of you who have read my blog before will know of Tony Nicklinson, a locked-in syndrome suffer, pursuing a "right-to-die" case.
His case to allow doctors to end his life via the use of lethal drugs without fear of prosecution was rejected last Thursday.
The case differed from other "right-to-die" cases which have focused on assisted suicide. Tony Nicklinson would be unable to take lethal drugs, even if they were prepared for him by someone else due to his condition, the paralysis of nearly all voluntary muscles however is mind is fully functioning.
Despite being rejected the case has gone further than other cases on assisted suicide in English and Welsh courts.
I have utmost respect and the deepest sympathy for Tony Nicklinson as I cannot imagine how he feels following the news however the general consensus amongst health officials is that the correct decision was made. This particular case is heart wrenching and Tony's wishes are very clear but the court passed judgement considering the bigger picture, had the result been different what affect would this have had in the future?
Although described as a "right-to-die" case Tony Nicklinson can end his life through the means of a hunger strike as described in a very interesting interview(see bottom of page) with Prof John Saunders however Tony Nicklinson understandably wishes to die in a more dignified, pain free way and to do so requires the help of a third party, doctors.
Detached from the emotion and sensitivity surronding the case several questions spring to mind, for example would such an act be murder? How would the doctor required to provide the "help" feel during/after the act?
This case along with many others highlights how complicated the issues surrounding assisted suicide are and how they incorporate a vast number of factors, not just the individual it concerns. For now the law on assisted suicide is to stay the same and each case will be dealt with on an individual basis and even then very few are accepted.
His case to allow doctors to end his life via the use of lethal drugs without fear of prosecution was rejected last Thursday.
The case differed from other "right-to-die" cases which have focused on assisted suicide. Tony Nicklinson would be unable to take lethal drugs, even if they were prepared for him by someone else due to his condition, the paralysis of nearly all voluntary muscles however is mind is fully functioning.
Despite being rejected the case has gone further than other cases on assisted suicide in English and Welsh courts.
I have utmost respect and the deepest sympathy for Tony Nicklinson as I cannot imagine how he feels following the news however the general consensus amongst health officials is that the correct decision was made. This particular case is heart wrenching and Tony's wishes are very clear but the court passed judgement considering the bigger picture, had the result been different what affect would this have had in the future?
Although described as a "right-to-die" case Tony Nicklinson can end his life through the means of a hunger strike as described in a very interesting interview(see bottom of page) with Prof John Saunders however Tony Nicklinson understandably wishes to die in a more dignified, pain free way and to do so requires the help of a third party, doctors.
Detached from the emotion and sensitivity surronding the case several questions spring to mind, for example would such an act be murder? How would the doctor required to provide the "help" feel during/after the act?
This case along with many others highlights how complicated the issues surrounding assisted suicide are and how they incorporate a vast number of factors, not just the individual it concerns. For now the law on assisted suicide is to stay the same and each case will be dealt with on an individual basis and even then very few are accepted.
Tuesday 14 August 2012
Doping
Unfortunately the Olympics are over but at least I will no longer be glued to the sofa and how well did Team GB do!?
It's time for my passion for science and sport to feature again as yesterday it was announced by the International Olympic Committee (IOC) that Belarusian women's shot put gold medallist Nadzeya Ostapchuk has been stripped of her title after failing a doping test.
Both samples of her urine (taken before and after the event) tested positive for metenolone which as the IOC states" is classified as anabolic agent under the 2012 prohibited list."
Metenolone is an anabolic steroid with testosterone like properties. By mimicking the effects of testosterone the drug increases the amount of protein synthesis occurring within body cells, which results in the build up of cellular tissue (known as anabolism), particularly in muscle cells.
To state the obvious such development provides an unfair advantage over other athletes within the sport and hence substances such as these are banned!
New Zealand's Valerie Adams, who was originally second, has now been awarded the gold medal.
Finally good luck to anyone receiving results this Thursday, I hope they go well for you!
It's time for my passion for science and sport to feature again as yesterday it was announced by the International Olympic Committee (IOC) that Belarusian women's shot put gold medallist Nadzeya Ostapchuk has been stripped of her title after failing a doping test.
Both samples of her urine (taken before and after the event) tested positive for metenolone which as the IOC states" is classified as anabolic agent under the 2012 prohibited list."
Metenolone is an anabolic steroid with testosterone like properties. By mimicking the effects of testosterone the drug increases the amount of protein synthesis occurring within body cells, which results in the build up of cellular tissue (known as anabolism), particularly in muscle cells.
To state the obvious such development provides an unfair advantage over other athletes within the sport and hence substances such as these are banned!
New Zealand's Valerie Adams, who was originally second, has now been awarded the gold medal.
Finally good luck to anyone receiving results this Thursday, I hope they go well for you!
Wednesday 8 August 2012
Tinnitus
When looking on the Internet for music festival tickets I became side tracked and came across a campaign which well known much artists Plan B and Chris Martin are supporting. The campaign is called "The Loud Music Campaign" and one of the medical conditions it warns about/offers advice on is Tinnitus.
Tinnitus is a sound that's heard in one or both ears for which there's no external source. The sounds appears to originate within the ear and is often described as a "ringing or buzzing" sound. There is actually nothing causing the sounds, it is a misinterpretation by the brain of signals from the nerves in the ear.
Tinnitus that occurs in only one ear could be more serious as it may be caused by an acoustic neuroma. Having only read briefly about acoustic neuromas in very simple terms an acoustic neuroma is a rare tumour that grows around the auditory vestibular nerve (acoustic nerve) that connects the ear to the brain. An acoustic neuroma is benign (not cancerous), which means it does not spread to other parts of the body. However, it can damage several important nerves as it grows and consequently cause effects such as tinnitus.
Episodes of tinnitus can be brief, for example after attending a loud music concert or permanent, for example Plan B is a permanent suffer having played many concerts over his career. Nowadays musicians use in ear filter plugs to protect their ears whilst they perform and the use of earplugs amongst spectators is something "The Loud Music Campaign" is trying to promote!
The most common causes are regular exposure to loud noises (eg loud music or loud noise in a workplace such as drilling) and excess ear wax which can also have a negative effect.
Tinnitus is a sound that's heard in one or both ears for which there's no external source. The sounds appears to originate within the ear and is often described as a "ringing or buzzing" sound. There is actually nothing causing the sounds, it is a misinterpretation by the brain of signals from the nerves in the ear.
Tinnitus that occurs in only one ear could be more serious as it may be caused by an acoustic neuroma. Having only read briefly about acoustic neuromas in very simple terms an acoustic neuroma is a rare tumour that grows around the auditory vestibular nerve (acoustic nerve) that connects the ear to the brain. An acoustic neuroma is benign (not cancerous), which means it does not spread to other parts of the body. However, it can damage several important nerves as it grows and consequently cause effects such as tinnitus.
Episodes of tinnitus can be brief, for example after attending a loud music concert or permanent, for example Plan B is a permanent suffer having played many concerts over his career. Nowadays musicians use in ear filter plugs to protect their ears whilst they perform and the use of earplugs amongst spectators is something "The Loud Music Campaign" is trying to promote!
The most common causes are regular exposure to loud noises (eg loud music or loud noise in a workplace such as drilling) and excess ear wax which can also have a negative effect.
Avoiding exposure to loud noise and earwax build-up can help prevent tinnitus. If there is a treatable underlying cause, once this is treated the tinnitus should disappear. In addition if tinnitus does begin to occur steps must be taken to ensure it doesn't get any worse!
Masking the noise with a background radio or a masking device (using white noise) helps to distract the person from their tinnitus.
Here is a link to a page on The Loud Music Campaign's website where you can find more information and an example mp3 clip of what tinnitus sounds like!
Friday 3 August 2012
UKCAT
I sat the UKCAT on Wednesday, glad its out of the way!
Having a well deserved break this week, at the olympics this weekend
Having a well deserved break this week, at the olympics this weekend
Monday 23 July 2012
Physical INactivity
Having just returned from a two week summer holiday the theme of inactivity, recently featured on the BBC Health page, is fresh on my mind!
We often hear about the importance of activity and the various health benefits it can have, there are adverts on the TV, leaflets posted through our doors advertising fitness groups and notices in school about what there is to get involved in.
A recent study published in the Lancet has taken the opposite approach investigating and reporting on the effects of inactivity! Here is the summary..
The study suggests that inactivity caused 9% of the deaths worldwide in 2008, equivalent to 5.3 million. Or roughly "one in 10 deaths from diseases such as heart disease, diabetes and breast and colon cancer."
It is recommended that adults do 150 minutes (2.5 hours) of moderate exercise each week, such as brisk walking or gentle cycling, anything less than this being considered inactivity.
The Lancet study also found people in higher income countries were the least active with those in the UK among the worst, as nearly two-thirds of adults were judged not to be doing enough exercise. This could be related to the lesser percentage employed in manual labour and the increased income in some cases allowing for luxuries such as washing machines instead of manual chores.
Increased physical activity is a priority within public health as an increase will ultimately lead to improved health, reduced disease and fewer deaths. Achieving this is easier said than done, perhaps the first steps are being put into place, improving access and providing information are key! For example I have recently seen new "outdoor gyms" in local parks to encourage physical activity, access is easy, the environment is a safe one and most of all the facilities are free!
We often hear about the importance of activity and the various health benefits it can have, there are adverts on the TV, leaflets posted through our doors advertising fitness groups and notices in school about what there is to get involved in.
A recent study published in the Lancet has taken the opposite approach investigating and reporting on the effects of inactivity! Here is the summary..
The study suggests that inactivity caused 9% of the deaths worldwide in 2008, equivalent to 5.3 million. Or roughly "one in 10 deaths from diseases such as heart disease, diabetes and breast and colon cancer."
It is recommended that adults do 150 minutes (2.5 hours) of moderate exercise each week, such as brisk walking or gentle cycling, anything less than this being considered inactivity.
The Lancet study also found people in higher income countries were the least active with those in the UK among the worst, as nearly two-thirds of adults were judged not to be doing enough exercise. This could be related to the lesser percentage employed in manual labour and the increased income in some cases allowing for luxuries such as washing machines instead of manual chores.
Increased physical activity is a priority within public health as an increase will ultimately lead to improved health, reduced disease and fewer deaths. Achieving this is easier said than done, perhaps the first steps are being put into place, improving access and providing information are key! For example I have recently seen new "outdoor gyms" in local parks to encourage physical activity, access is easy, the environment is a safe one and most of all the facilities are free!
Thursday 5 July 2012
Kinesio Tape
"Kinesio tape" has in fact been around for a few years, since 2008, however it has become more and more popular in the past year and I have seen the tape being worn by rugby players in the six nations and most recently by Mario Balloteli in Euro 2012 however the name of the tape was unknown to me. The recent article on the tape by the BBC, which is in fact called "kinesio tape"has allowed me to find out more!
The tape got its name from kinesiology which is the scientific study of human movement!
The article by the BBC can be found here, another source of information is the introductory video by Kinesio themselves which can be found here
The tape is described to have four main effects: to encourage correct muscle function, improve circulation, provide pain relief and repositioning of a subluxed joint (a "partial dislocation" of a joint)
The scientific claims which have not yet been proven as research is still ongoing are that the tape lifts the skin enabling the circulation of lypmh and blood and therefore relieving pressure. As there is less pressure on the pain receptors less pain will be felt and the reduction of fluid in the named area will lead to less inflammation.
There is also the power of the placebo effect to be considered, having used the tape myself once during a rugby tournament it may have simply been my belief which allowed me to see "results". Perhaps the injury would have improved without the tape? The tape provided support however any old tape would have also done this, its impossible to tell whether the pain and swelling reduction was aided by the Kinesio tape.
Until the research is complete the claims can't be verified however at present medical professionals and physios are using the tape to treat patients with injuries, particularly those obtained in sport.
The tape got its name from kinesiology which is the scientific study of human movement!
The article by the BBC can be found here, another source of information is the introductory video by Kinesio themselves which can be found here
The tape is described to have four main effects: to encourage correct muscle function, improve circulation, provide pain relief and repositioning of a subluxed joint (a "partial dislocation" of a joint)
The scientific claims which have not yet been proven as research is still ongoing are that the tape lifts the skin enabling the circulation of lypmh and blood and therefore relieving pressure. As there is less pressure on the pain receptors less pain will be felt and the reduction of fluid in the named area will lead to less inflammation.
There is also the power of the placebo effect to be considered, having used the tape myself once during a rugby tournament it may have simply been my belief which allowed me to see "results". Perhaps the injury would have improved without the tape? The tape provided support however any old tape would have also done this, its impossible to tell whether the pain and swelling reduction was aided by the Kinesio tape.
Until the research is complete the claims can't be verified however at present medical professionals and physios are using the tape to treat patients with injuries, particularly those obtained in sport.
Saturday 30 June 2012
More Open Days!
I visited Oxford and Newcastle University this week! I thoroughly enjoyed my time at both universities and I think its even clearer now that if I was lucky enough to get into any medical school i'd have a fantastic time!! I thought that the city of Oxford was lovely and I found the collegiate system very attractive, the obvious problem with Oxford is how competitive and difficult it is to get in. Even more difficult that the other medical schools perhaps! I fell in love with the sports centre at Newcastle and liked how close the campus was to the city centre.. In addition Newcastle often scores very highly in student satisfaction surveys and I can see why! Finally it may have been perception but I thought everyone I met was very friendly, both at the university and in the centre.
I plan to look at more universities over the summer, if possible in person, otherwise via the internet and prospectuses. I think the open days I have attended so far have confirmed my desire to study at a campus university and have made me even keener to study medicine having heard about the courses in detail! There is only one large barrier, getting the grades and being successful in the selection process..
A few months ago I posted about a man called Tony Nicklinson who is suffering from "locked in" syndrome and has been for seven years following a stroke. He is paralysed yet his mind is fully functional. His plea for death is due to go to trail very soon, he does not wish for a new law to be put in place - simply a remedy for his particular case, which is a desire to die to end his suffering. His condition is so severe that the suicide would not be assisted, instead he would have to be killed by medical means, Euthanasia.
There are obviously many complications surrounding the case and time must be spent considering them and a conclusion, the ruling will occur at a later date after some time. There are many arguments for and against the case, for example Tony's mind is fully functional so surely it is his decision whether or not he wants to die, not the states? However by contrast, would the permission for Tony to end his life with the help of medical support be murder?
I plan to look at more universities over the summer, if possible in person, otherwise via the internet and prospectuses. I think the open days I have attended so far have confirmed my desire to study at a campus university and have made me even keener to study medicine having heard about the courses in detail! There is only one large barrier, getting the grades and being successful in the selection process..
A few months ago I posted about a man called Tony Nicklinson who is suffering from "locked in" syndrome and has been for seven years following a stroke. He is paralysed yet his mind is fully functional. His plea for death is due to go to trail very soon, he does not wish for a new law to be put in place - simply a remedy for his particular case, which is a desire to die to end his suffering. His condition is so severe that the suicide would not be assisted, instead he would have to be killed by medical means, Euthanasia.
There are obviously many complications surrounding the case and time must be spent considering them and a conclusion, the ruling will occur at a later date after some time. There are many arguments for and against the case, for example Tony's mind is fully functional so surely it is his decision whether or not he wants to die, not the states? However by contrast, would the permission for Tony to end his life with the help of medical support be murder?
Thursday 21 June 2012
Birmingham Open Day
My most recent medically related activity was visiting Birmingham University today!
For anyone interested there have been several changes to the admissions requirements, an admissions tutor told us the following:
- There is no longer a 7A* GCSE threshold but instead a requirement of an A* in Science, Maths and English GCSE
- Four As are required at AS level
- The typical offer for the upcoming year will be A*AA
- MMIs (Multiple Mini Interviews) are being introduced instead of a panel interview, initially with 4 stations each lasting between 5-8 minutes
I thoroughly enjoyed my day and thought the campus was brilliant! It was cool and very convenient arriving at the university's own train station and the sports facilities were excellent with a swimming pool and an impressive gym. There are opportunities to get involved with sport at all levels from university to subject teams, something which I am particularly interested in! Not only that but they are also planning to improve the sports facilities even more!
Today was my first university open day and I was impressed by the accommodation on all levels, it went beyond my expectations! It is definitely somewhere I would enjoy living and the students who were there were very honest about the advantages and disadvantages surrounding life at a campus university.
For anyone interested there have been several changes to the admissions requirements, an admissions tutor told us the following:
- There is no longer a 7A* GCSE threshold but instead a requirement of an A* in Science, Maths and English GCSE
- Four As are required at AS level
- The typical offer for the upcoming year will be A*AA
- MMIs (Multiple Mini Interviews) are being introduced instead of a panel interview, initially with 4 stations each lasting between 5-8 minutes
I thoroughly enjoyed my day and thought the campus was brilliant! It was cool and very convenient arriving at the university's own train station and the sports facilities were excellent with a swimming pool and an impressive gym. There are opportunities to get involved with sport at all levels from university to subject teams, something which I am particularly interested in! Not only that but they are also planning to improve the sports facilities even more!
Today was my first university open day and I was impressed by the accommodation on all levels, it went beyond my expectations! It is definitely somewhere I would enjoy living and the students who were there were very honest about the advantages and disadvantages surrounding life at a campus university.
Thursday 14 June 2012
A study published in Science Translational Medicine..
The study is a very interesting one and talks of "hitch-hiking" anti-cancer viruses travelling on blood cells, if you have time have a look here! If not here it is briefly summarised:
The reoviruses which combat the cancer tumours "sneak" around the body on blood cells themselves (not in the blood plasma) enabling them to evade the body's immune system and are therefore not destroyed!
The viruses are able to kill cancerous tumour cells and leave the surrounding tissues unharmed.
The viruses have been used in patients with advanced bowel cancer. Following an injection the virus was detected in the tumour but not in the liver itself. This suggests the virus is able to selectively target the cancerous cells!!
The professor at the University of Leeds behind the trails believes eventually these viruses will be "used in combination with chemotherapy" to treat cancer.
We will soon see.. Further trials are being carried out in patients with neck and head cancer and studies using genetically modified viruses are also being carried out in America.
The reoviruses which combat the cancer tumours "sneak" around the body on blood cells themselves (not in the blood plasma) enabling them to evade the body's immune system and are therefore not destroyed!
The viruses are able to kill cancerous tumour cells and leave the surrounding tissues unharmed.
The viruses have been used in patients with advanced bowel cancer. Following an injection the virus was detected in the tumour but not in the liver itself. This suggests the virus is able to selectively target the cancerous cells!!
The professor at the University of Leeds behind the trails believes eventually these viruses will be "used in combination with chemotherapy" to treat cancer.
We will soon see.. Further trials are being carried out in patients with neck and head cancer and studies using genetically modified viruses are also being carried out in America.
Tuesday 5 June 2012
"Abuse" of painkillers
My interest in sport and the up and coming Euro 2012 competition drew my attention to this article, here it is if anyone wants to take a look
It talks about the use of pain killers and nsaids (non-steroidal anti-inflammatory drugs) by sports people, in this case footballers.
Research from the 2010 South African football world cup showed that 39% of all players took a painkilling agent before every game in order to prevent any pain which may occur during the game enabling them to play on.
The use of painkillers in football is still increasing, the researchers suggest this is due to the eagerness of clubs to keep their best players on the pitch at all times (which I agree with) and this can consequently put pressure on sports doctors to try and do just this!
The use of painkillers can put strains on the kidneys and liver, during exercise a player's kidneys are working hard which makes them more vulnerable to damage from strong medication.
Croatian striker Ivan Klasnic believes that the kidney failure he suffered from in 2007 may have been caused by the painkilling medication he received whilst at his club. The matter is still before the courts however so the cause is not known for sure.
It talks about the use of pain killers and nsaids (non-steroidal anti-inflammatory drugs) by sports people, in this case footballers.
Research from the 2010 South African football world cup showed that 39% of all players took a painkilling agent before every game in order to prevent any pain which may occur during the game enabling them to play on.
The use of painkillers in football is still increasing, the researchers suggest this is due to the eagerness of clubs to keep their best players on the pitch at all times (which I agree with) and this can consequently put pressure on sports doctors to try and do just this!
The use of painkillers can put strains on the kidneys and liver, during exercise a player's kidneys are working hard which makes them more vulnerable to damage from strong medication.
Croatian striker Ivan Klasnic believes that the kidney failure he suffered from in 2007 may have been caused by the painkilling medication he received whilst at his club. The matter is still before the courts however so the cause is not known for sure.
Saturday 2 June 2012
Post exams
Its been almost a month since my last post and I felt I should write something briefly before I get back into the full swing of things!
Exams are over!! I hope they went well for everyone..
The next step for me is visiting universities for open days and then at some point over the summer taking the UKCAT.
I was wondering wether anyone was planning to do one of the organised revision courses for the UKCAT? Also if anyone had any "revision material" for the test which they thought was particularly good and would recommend?
Exams are over!! I hope they went well for everyone..
The next step for me is visiting universities for open days and then at some point over the summer taking the UKCAT.
I was wondering wether anyone was planning to do one of the organised revision courses for the UKCAT? Also if anyone had any "revision material" for the test which they thought was particularly good and would recommend?
Sunday 6 May 2012
Pioneering eye implants!
Two British men who have been completely blind for more than a decade have had their sight partially restored thanks to an electronic chip implant allowing them to perceive light and make out basic shapes, for example distinguishing between a straight
and curved line. Although the development seems small it is
understandably extremely significant to someone how has seen nothing but
darkness for years and it is hoped that the sight will improve over time.
Both men lost their sight due to retinitis pigmentosa which is described as when the photoreceptor cells at the back of the eye gradually cease to function. The 3mm electronic chip takes over the photoreceptor cells function, the chip contains 1500 light sensitive pixels and was placed behind the retina in both patients. A fine cable runs to a control unit which is situated underneath the skin behind the ear.
Light rays stimulate the pixels to send electronic signals to the optic nerve and these signals then travel onto the brain. These signals cause the brain to receive flashes of light rather than conventional vision and images are in black and white. The trial is in its early stages and the patients must learn to interpret the signals sent to their brain, hopefully this will then improve the detail which can be seen.
Another unique aspect of this development is that the device is portable, unlike the chip received by a Finnish man in 2010 which only worked in laboratory settings.
As of yet stem cell research related to restoring eye sight has only included people with residual vision where as these trials involve two patients who previously had no vision whatsoever.
Both men lost their sight due to retinitis pigmentosa which is described as when the photoreceptor cells at the back of the eye gradually cease to function. The 3mm electronic chip takes over the photoreceptor cells function, the chip contains 1500 light sensitive pixels and was placed behind the retina in both patients. A fine cable runs to a control unit which is situated underneath the skin behind the ear.
Light rays stimulate the pixels to send electronic signals to the optic nerve and these signals then travel onto the brain. These signals cause the brain to receive flashes of light rather than conventional vision and images are in black and white. The trial is in its early stages and the patients must learn to interpret the signals sent to their brain, hopefully this will then improve the detail which can be seen.
Another unique aspect of this development is that the device is portable, unlike the chip received by a Finnish man in 2010 which only worked in laboratory settings.
As of yet stem cell research related to restoring eye sight has only included people with residual vision where as these trials involve two patients who previously had no vision whatsoever.
Friday 27 April 2012
Cardiology
I volunteered as usual on the cardiology ward this evening and met a very interesting man who had just arrived and began talking to me. He told me about his two sons who are both very bright, with science related careers. One of whom moved to Australia several years ago and is a specialist biomedical engineer and has made millions!
I'm quite nervous about the upcoming exams but hopefully I will do well and I hope that you all get the grades you're hoping to get too!
I just read an interesting heart related article about the repairing of scar tissue caused by heart attacks using gene therapy and thought I would post a link here incase anyone wanted to have a quick read! Who knows, perhaps these findings could be significant! (Or on the other hand insignificant..) We shall see.
I'm quite nervous about the upcoming exams but hopefully I will do well and I hope that you all get the grades you're hoping to get too!
I just read an interesting heart related article about the repairing of scar tissue caused by heart attacks using gene therapy and thought I would post a link here incase anyone wanted to have a quick read! Who knows, perhaps these findings could be significant! (Or on the other hand insignificant..) We shall see.
Wednesday 18 April 2012
Biomedical engineering
I attended a lecture on biomedical engineering after school today given by a lecturer on the course at Kings College London. The course is relatively new at Kings and the entry requirements are AAA - including physics and maths.
I did not know what to expect but my reasons for going were that I knew it would be interesting in terms of science and technology and such fields are likely to play an increasingly important role in the future! I personally am not considering biomedical engineering but know it could be an alternative to medicine if I were to fail to get into medicine more than once..
The course involves four main things:
1.) Computation eg computers which can read scans for tumours based on the shade and resolution of the scan
2.) Software and modelling eg programmes with the ability to track excitation waves in the heart and consequently makes improvements on things such as heart fibrillation and why a defibrillator works
3.) Imaging eg 3D images of areas with a higher metabolic rate than usual likely to be tumours dividing
4.) Robotics and devices eg devices which are able to give doses of radiation to pin point accuracy
All of the areas sound extremely interesting and considering the advancements made in the past 50 years who knows what will be developed in the next 50 years time!? Hopefully a time when we are practicing medicine..
I did not know what to expect but my reasons for going were that I knew it would be interesting in terms of science and technology and such fields are likely to play an increasingly important role in the future! I personally am not considering biomedical engineering but know it could be an alternative to medicine if I were to fail to get into medicine more than once..
The course involves four main things:
1.) Computation eg computers which can read scans for tumours based on the shade and resolution of the scan
2.) Software and modelling eg programmes with the ability to track excitation waves in the heart and consequently makes improvements on things such as heart fibrillation and why a defibrillator works
3.) Imaging eg 3D images of areas with a higher metabolic rate than usual likely to be tumours dividing
4.) Robotics and devices eg devices which are able to give doses of radiation to pin point accuracy
All of the areas sound extremely interesting and considering the advancements made in the past 50 years who knows what will be developed in the next 50 years time!? Hopefully a time when we are practicing medicine..
Friday 6 April 2012
Malaria
A very short post on an article I read today having heard the nurses at volunteering speaking about it. The article describes research showing new evidence that the the number of parasites resistant to "front line" malarial drugs is increasing.
Resistant strains of the parasite to drugs derived from the Artemisia annua plant have recently been found 500 miles away from the original sites and more data is still being collected.
If resistance continues to rise this would be a major set back and the discovery of a vaccination against the disease would take much longer.
The disease killed more than 665,000 people in 2010 - equivalent to more than 1 every minute.
I may add to this post in greater depth if I find out more, if anyone knows or has read anything related feel free to comment!
I hope everyones revision is going well!
Resistant strains of the parasite to drugs derived from the Artemisia annua plant have recently been found 500 miles away from the original sites and more data is still being collected.
If resistance continues to rise this would be a major set back and the discovery of a vaccination against the disease would take much longer.
The disease killed more than 665,000 people in 2010 - equivalent to more than 1 every minute.
I may add to this post in greater depth if I find out more, if anyone knows or has read anything related feel free to comment!
I hope everyones revision is going well!
Friday 30 March 2012
Tuberculosis (TB)
We learnt briefly about TB in AS Biology this week so I thought I would do a small bit of research on the disease and write briefly about it here.
It is an infectious disease transmitted by airborne droplets of Mycobacterium, usually Mycobacterium tuberculosis however it is not highly infectious and additional circumstances often contribute to its spread, for example overcrowding, poor housing or an already weakened immune system.
The disease can affect any area of the body but it is usually the lungs that are affected. The alveoli cells become infected and damaged, as do the surrounding blood vessels. This can lead to the coughing up of blood and pus (which can be fatal) but is often prevented by the use of antibiotics.
These antibiotics need to be taken continually for at least 6 months – a regime which is much harder to implement in less developed countries. In addition a resistance is being observed in some cases (due to patients not finishing the full course of antibiotics for whatever reason) so the use of dual antibiotic treatment may occur.
Whilst researching I came across this article, showing an 8% rise in cases in London. It is thought to be caused by an increase in homelessness in the city (poor housing is one of the influencing factors I discovered earlier). Migration could also influence in the spread of the disease, with people migrating to London from less developed countries where the disease is more common.
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