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)
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