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)

'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.”

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%"

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?