'Shame on us nurses'

By Prof Ian Peate Consultant editor, British Journal of Nursing

Following the Care Quality Commission's recent report on what it called "alarmingly" poor care for elderly hospital patients, leading nurse Prof Ian Peate says in this week's Scrubbing Up that the profession should look again at how it trains people to look after older people.

Once again we read about the disgraceful care of our elderly and frail population and once again I cringe with embarrassment as I read how we abuse the people who we have the privilege to care for.
Yes I know there are some excellent examples of high quality outstanding care provided to people. But there is something seriously wrong here.
Nursing is well on its way to setting minimum standards for a degree level nursing programme and justifiably so, given the complexities of care and the demands the public rightly make in insisting on high quality, safe and effective care.
The Nursing and Midwifery Council (NMC) regulates nurses and midwives in the UK.
It sets standards for education, attempting to ensure that nurses possess the right skills and qualities when they start work as a qualified nurse.
What the NMC does not do is stipulate any mandatory requirements for elderly care. They leave this up to the individual educational institutions, so each will approach the teaching of elderly care in a variety of ways.
The time has come for the NMC to compel those running courses to stipulate how much time should be dedicated to the care of the elderly, in practice and theory.
There is a need to ensure that students of nursing - our future staff nurses who will be looking after me when I am older - are able to care confidently and competently for older people - geriatrics.
'High touch' - not high-tech
The art and science of gerontology has all but gone and this is a pity.
As a nursing student I was privileged to take a course that instilled in me the skills required to care for geriatrics patients, responding to their unique needs as people who have a number of concurrent illnesses and take a variety of medications.
If nurses get the care of older people right by applying the theory to practice, paying attention to feeding them and providing them with fluids, washing and cleaning them when they are unable to wash themselves, communicating with them and encouraging them through caring, kindness and compassion then caring for other patients will come naturally.

“Start Quote

We need to say sorry to our patients and to tell them what we are going to do to get it right”

End Quote Prof Ian Peate

These are high level skills that require the nurse to apply scientific principles to the art of caring.

As a student I was assessed, on the job - by an experienced nurse - in caring for geriatric patients. But that specific check is no longer required.
We should not be ashamed, embarrassed or made to feel politically incorrect when using the term geriatric.
It is a speciality, with care provided by skilled practitioners, on the geriatric ward as opposed to a busy acute medical ward where high-tech is favoured and preferred over "high-touch".
We have witnessed our medical colleagues embrace so-called "soft skills" (communication skills, a good bedside manner) through their improved undergraduate education.
NMC take heed.
Demand the curriculum you validate has explicit elements of geriatric care in them, in the classroom and on the ward; direct that no student will progress if they do not pass the an elderly care part of their course; continue to reinforce the need for all staff to speak out when they witness substandard or abusive care but also insist that those who speak out are supported.
Shame on us nurses.
We need to say sorry to our patients and to tell them what we are going to do to get it right, and we need to be brought to account each time we fail to provide care that is compassionate, kind and humane.

Cancer cases projected to rise 45% in next two decades

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Big projected rise in new cancer cases

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The number of new cancer cases in the UK could rise by 45% by 2030 to more than 430,000 a year, research suggests.

The rise is explained almost entirely by the expected increase in the number of people living in the UK and the ageing population.

Cancer Research UK, which funded the studypublished in the British Journal of Cancer, says the NHS must act now to avoid being "overwhelmed".

The Department of Health said it was already responding to the challenge.

The research presents projections for 23 different types of cancer. The results are based on taking figures from cancer registries going back to 1975, and then projected forwards to 2030, taking into account expected changes in population.

The study suggests that the number of new cases could rise from about 298,000 in 2007 to 432,000 by 2030 - an increase of 45%. The increase in men is forecast to be 55%, and 35% in women.

Drawing on data from the Office for National Statistics, the authors assume a rise in the population from 61m in 2007 to nearly 71m by 2030.

The proportion of elderly people is projected to grow at a faster rate. The figure for over 65s stood at 16% in 2007. By 2030 it is expected to reach 22%.

Continue reading the main story

“Start Quote

The NHS faces a perfect storm over the next 20 years.”

Harpal KumarCancer Research UK chief executive,

The impact of ageing is starkly reflected in the projected increase in the figures for prostate cancer, which is especially common in older men.

Cases are projected to increase from about 36,000 in 2007 to more than 61,000 by 2030. The authors say even this is probably an under-estimate because in future more men are likely to be tested for the disease.

Although the overall number of cancer cases appears set to rise, the authors conclude that after adjusting for the growing and ageing population, cancer rates are likely to remain "broadly stable". But there are variations within this.

The rate of breast cancer is projected to fall by 7%. The authors attribute this to a recent reduction in the use of hormone replacement therapy, which is a risk factor for the disease.

However the rates of malignant melanoma and kidney cancer are forecast to rise sharply in men and women.

One of the authors, Prof Peter Sasieni acknowledged that the figures should be treated with caution, but said they provided a framework.

"Projections of cancer cases are important for planning health services so we can understand where the future burden is on the NHS and also where health awareness messages need to be raised."

Cancer Research UK chief executive Harpal Kumar added: "At a time when the finances of the health service are being squeezed, it is absolutely crucial that health commissioners plan now for a massive increase in demand for cancer services, to ensure we provide high quality care to all."

The charity's director of health information, Sara Hiom, said: "Smoking and drinking alcohol are two of the biggest things that increase the chance of developing oral, liver and kidney cancer - so by stopping smoking and cutting back on alcohol, we can lower our risk of these cancers as well as other diseases.

"Maintaining a healthy bodyweight is also important in cutting the risk of liver and kidney cancers."

A spokesman for England's Department of Health said the NHS was already responding to the challenge of an ageing population and increases in cancer cases.

"That is why we are investing more than £750m over the next four years to make sure people are diagnosed with cancer earlier and have better access to the latest treatments," he added.

• Four in 10 get cancer - charity 14 JULY 2011, HEALTH
• Cancer survival rates 'doubled' 12 JULY 2010, HEALTH

• British Journal of Cancer
• Cancer Research UK

poachers demand up to $40,000 an animal

Poachers demanding $40,000 (£25,350) for one of the animals were caught by park rangers earlier this month in an undercover sting operation.

It was the fourth such incident since April, making this a record year for the poachers trying to feed a growing black market caught with baby gorillas.

Mountain gorillas are critically endangered, with around 790 remaining in the world - about 480 in the Virunga volcanoes conservation area (shared by DR Congo, Rwanda and Uganda) and just over 300 in the Bwindi Impenetrable Forest in Uganda. Eastern lowland gorillas are more numerous but largely outside protected areas and still in decline.

Emmanuel de Merode, director of Virunga national park, said: "We are very concerned about a growing market for baby gorillas that is feeding a dangerous trafficking activity in rebel controlled areas of eastern DRC.

"We are powerless to control the international trade in baby gorillas, but our rangers are doing everything they can to stamp it out on the ground." Merode added: "Four baby gorillas seized in less than a year is unusually high … [but] it's only the tip of the iceberg, as we only manage to catch a small proportion of the offenders because the wildlife service is under-resourced in Congo."

An infant gorilla was rescued on 6 October when a team of park rangers went undercover posing as potential buyers in the town of Kirumba, near the western border of the park.

Dressed in civilian clothes, they made contact and agreed a price for the one-and-a-half-year-old male eastern lowland gorilla that poachers were hiding in a small backpack. Rangers arrested the three poachers once they had possession of the gorilla.

Christian Shamavu, the leader of the operation, said: "It's very likely that the mother and other gorillas were killed because it's very difficult to take a baby gorilla from its family. The poachers will never admit to this, though."

Baby eastern lowland gorillas were confiscated from poachers in DR Congo in April and June, and Rwandan police recovered a baby mountain gorilla as poachers attempted to smuggle it over the border in August.

The animals suffer physical anguish during the process. Dr Jan Ramer, a vet with Mountain Gorilla Veterinarian Project (MGVP), partners with Virunga national park, said: "Many of these infants are injured from ropes around their hands, feet or waist, and some are quite ill, which is not surprising as they are generally in close contact with their human captors, extremely stressed, and with very poor nutrition."

But the newest orphan gorilla, named Shamavu after the ranger who rescued him, appears to be in good condition, Ramer added. "He appears to be quite healthy other than some parasites and dry skin."

The market price for infant gorillas can reach $40,000, but officials say they lack the resources or jurisdiction to investigate where the gorillas are headed or who is behind the trafficking.

International experts said they believe the route lies east. Ian Redmond, chairman of the conservation group the Ape Alliance, said: "We think the Middle East is a likely source of demand, wealthy animal collectors and a tradition of giving big gifts to curry favour … and maybe wealthy Russians, but there is little hard evidence.

"What we do know is that just the rumour that someone is looking to buy a baby ape can be enough for penniless hunters to think: 'I could get one of those and sell it for $$$$!' And in eastern DRC, once one is captured it is likely to be smuggled eastwards through either Rwanda or Uganda, the traditional trade routes for all goods in that area."

A report on ape trafficking by Karl Ammann, an investigative film maker, claimed that dozens of gorillas and hundreds and chimpanzees have been taken from Cameroon via Nigeria to Egypt.

Emmanuel de Merode added: "Surveillance is the key, at the borders, in the towns, along the roads. The local community are the best surveillance system, if they are on our side.

"A lot more could be done with respect to international trade, especially in the market countries where there is demand for baby gorillas. There, it's a question of enacting legislation and enforcing. As far as I know, very little has been done that's effective with respect to baby gorilla trafficking."

The drought in the Horn of Africa has put nearly 13.3million people in urgent

World Bank Group

Fact Sheet September 10, 2011

Response Plan

Drought in the Horn of Africa

1. The drought in the Horn of Africa has put nearly 13.3million people in urgent need of

humanitarian aid across Somalia, Ethiopia, Kenya, and Djibouti. The crisis has been escalating

dramatically in recent months, especially in Somalia, and as a result more people, crops and livestock

will be affected in the coming months.

2. Somalia remains by far the most affected country, with an estimated 40 percent of its total

population affected, living as internally displaced people or at refugee camps in neighboring countries

(primarily Kenya and Ethiopia). The Dadaab camp in Kenya is now the largest refugee settlement in the

world.

3. The situation is compounded by steep increases in food prices, which further undermine food

security in the region, with particularly adverse effects on poor households. Cereal prices are currently at

record levels in Somalia, Ethiopia and Kenya. The flow of refugees is putting additional pressure on

food markets across the sub-region, including in areas that were not directly impacted by the drought.

4. The World Bank’s International Development Association (IDA), the donor-funded Global

Facility for Disaster Reduction and Recovery (GFDRR), and the State and Peace Building Fund (SPF)

are making available $1.88 billion to respond to the drought crisis in three phases: the Rapid Response

phase covering the first six months, the Economic Recovery phase covering the first two years, and the

Drought Resilience phase focusing on implementation over a longer period of time.

5. The overall thrust of the Bank’s response seeks to link short-term crisis mitigation with longterm

development objectives both at country and regional levels.

Africa Region

World Bank Response – immediate, medium and long term interventions

Six months to

two years

Two to five years

First six months

Rapid

Response

Economic

Recovery

Drought

Resilience

- Increasing safety nets

- Cash transfer & cash for

work programs

- Recovery planning

- Early livelihood recovery

- Jump-starting crop and

livestock production

- Strengthen health facilities

- Resilience & preparedness

- Investments in drought

resilient agriculture, water

- Risk financing, resilience

planning & preparedness

- Investments in social

safety nets

Phases Timing Interventions

-Scaling up operations

through additional financing

- Reallocating operations

- Projects with contingency

and risk financing component

- New emergency projects

- Additional financing

- Emergency Recovery Loans

- Scaling up focus on drought

resilience through regular

investments

Instruments

Increased

livelihood

protection for

vulnerable

groups

Affected

people’s

livelihoods

enhanced

Impact of

drought

mitigated in the

coming years

Outcomes

$288 Million

$384 million

$1.2 billion

World Bank Group

Fact Sheet September 10, 2011

2

6. The first phase has already started and for which $288 million has been allocated for rapid response needs. This phase will continue till early 2012. Activities under this phase will aim at increasing livelihood protection for drought affected by supporting public health response, as well as providing critical safety nets in affected communities. In particular, emphasis is being placed on cash for work programs, cash transfers, health screenings and nutrition schemes targeting vulnerable populations, especially women and children. Resources allocated in this initial phase are also helping with recovery planning.

7. In the economic recovery phase, $384 million have been earmarked as medium-term needs. Activities under this phase will aim on boosting crops and livestock production through improved land management and efficient irrigation techniques. The overall objective will be to strengthen livelihood recovery.

8. The third and final phase, for which $1.2 billion has been allocated, will reinforce and amplify the Bank’s longstanding focus in building drought resilience in the sub-region. In particular, resources will be allocated to investments in drought resilient agriculture, risk financing, resilience planning and strengthening social safety nets.

9. Immediate relief and recovery in the hardest hit areas in Somalia remains an important priority. Political instability impedes access by humanitarian agencies and development partners, but United Nations agencies such as the FAO and the UNHCR have an ongoing presence and a proven ability to deliver in Somalia’s most affected areas. A $9 million project has been mobilized through GFDRR and the SPF for a proposed Drought Management and Livelihood Protection Project in Somalia that will help provide basic supplies to more people. The project will be implemented by FAO.

10. The severity, scale and regional dimension of the drought emergency in the Horn of Africa calls for a coordinated international response where the various partners each maximize their areas of competitiveness. To this end, a $30 million Horn of Africa Emergency Health and Nutrition Project supported by IDA CRW funds has been prepared, which will be implemented through UNHCR. These resources will go toward scaling up health, nutrition, and sanitation services at the two largest refugee settlements (Daabab camp in Kenya and the Dollo Ado in Ethiopia), so as to keep pace with the rapidly growing population and related risks.

Drought

Response

World Bank

UN

(WFP, FAO,

UNICEF,

UNHCR, WHO)

Regional

Organizations

IGAD, EAC,

AU

National

Governments

NGOs

and CSO

Science

FEWSnet,

NASA

Bi-lateral

Donors

IFRC

Red Cross

and Crescent

European

Union

World Bank Group

Fact Sheet September 10, 2011

3

11. The full scale of the economic impact of the drought emergency is not yet appraised, but could be far-reaching. The World Bank experts are contributing to a comprehensive needs assessment that will help inform the scale and form of interventions in the economic recovery and drought resilience phases of the response plan.

12. Following decades of recurring droughts in the Horn of Africa, several World Bank-financed projects have established contingency and risk financing mechanisms that can be used for rapid response to drought crises. In this context, Risk financing mechanism has been triggered under Productive Safety Net Program for Transitory Food Insecurity and $134.7 million has been made available for immediate disbursement. The project will cover 6.5 million beneficiaries and 311,252 transitory food insecure people till November.

13. The World Bank is reviewing a range of projects that can deliver additional financing to prompt economic recovery and drought resilience so recurring droughts do not take such a heavy human toll. Under the Rapid Response Plan, the World Bank has mobilized seven out of ten projects that are proposed to be financed (Additional Finance) from the Crisis Response Window resources. These projects are:

(1) Ethiopia: Productive Safety Net Program; cost $537 million; $70 million under CRW

(2) Kenya: Water and Sanitation Project; Project cost $50 million; $20 million under CRW

(3) Kenya: Health Sector Support Project; Project cost $56.9 million; $56.8 under CRW

(4) Djibouti: Employment &Human Capital Safety Net; cost $8.6 million; $5 under CRW

(5) Djibouti: GFDRR & TFEESD; Project cost $6.2 million; $3.5 required under CRW

(6) Djibouti: Rural Community Dev. & Water Mobilization; cost $7.8; $2 mil. under CRW

(7) Djibouti: Emergency grants for diesel/energy etc.; cost $2.7 million required under CRW

14. Community driven development programs will be supported, including water and sanitation projects, small-scale irrigation for agriculture, or broad support to drought affected farmers and farming activities. Incomes will be recovered through cash grants, public work schemes for temporary income, asset replacement, and micro-insurance schemes. As noted above, some of these interventions are already underway.

Although the region has faced droughts for decades, climate change is making them more intense.

15. In the longer term, it is important that countries in the Horn of Africa prepare for recurring droughts and the World Bank is supporting these efforts.

16. When combined with the region’s population increase, droughts are expected to lead to higher socio-economic impacts in years to come. Climate-smart agriculture is a priority and cross-border strategies for drought risk reduction are needed. The donors and development partners can help by supporting smallholder farmers with seeds, fertilizer, better weather forecasting, and monitoring crop production; creating better ways to get produce to markets; providing food and effective social safety nets for the most vulnerable.

World Bank Group

Fact Sheet September 10, 2011

4

17. The World Bank is boosting agriculture and agriculture-related investment to $6-$8 billion a year from $4.1 billion in 2008.

18. Specifically, the World Bank’s Agriculture Action Plan emphasizes increased support in five areas: raising agricultural productivity; linking farmers to markets; reducing risk and vulnerability; improving nonfarm rural employment; and making agriculture more environmentally sustainable, as well as a source of positive environmental services.

For information on the Global Center for Conflict, Security and Development in Nairobi, visit here.

www.worldbank.org/africa

Facebook: http://www.facebook.com/worldbankafrica

Twitter: http://www.twitter.com/worldbankafrica

YouTube: http://www.youtube.com/worldbank

Somali piracy: Armed guards to protect UK ships

Use of armed guards would be restricted to voyages through particular waters in affected areas

Continue reading the main story

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• UN sanctions anti-piracy guards
• The losing battle against Somali piracy
• 
  

Ships sailing under a British flag will be able to carry armed guards to protect them from pirates, the prime minister has announced.

David Cameron says he wants to combat the risks to shipping off the coast of Somalia, where 49 of the world's 53 hijackings last year took place.

No ship carrying armed security has yet been hijacked, the government claims.

However, allowing ships to carry armed guards may fall foul of laws in other countries, such as South Africa.

Many British-registered ships already illegally carry armed guards because companies feel they have no alternative.

Shoot to kill?

Mr Cameron revealed he wanted to make the practice legal after talks in Australia with Commonwealth leaders from the region over the escalating problem faced in waters off their shores.

Asked if he was comfortable with giving private security operatives the right to "shoot to kill" if necessary, Mr Cameron told BBC1's Andrew Marr Show: "We have to make choices.

"Frankly, the extent of the hijack and ransom of ships round the Horn of Africa is a complete stain on our world.

Continue reading the main story

"The fact that a bunch of pirates in Somalia are managing to hold to ransom the rest of the world and our trading system is a complete insult and the rest of the world needs to come together with much more vigour."

France and Spain provide so-called military vessel protection detachments, while Italy is planning a similar measure.

However, in July, Foreign Office Minister Henry Bellingham said limited resources in the light of current military commitments could not allow Royal Marines to do the same.

Under the plans, the Home Secretary will be given the power to license vessels to carry armed security, including automatic weapons, currently prohibited under firearms laws.

Targeting assets

Officials said up to 200 could take up the offer, which would only apply for voyages through particular waters in the affected region.

Other counter-piracy measures being taken include offering support from Treasury officials to Kenya to help its officials track down pirates' assets.

Mr Cameron also said help could be given to countries such as The Seychelles and Mauritius who were acting to bring pirates to court and imprison them.

• UN sanctions anti-piracy guards 21 MAY 2011, AFRICA
• The losing battle against Somali piracy 10 FEBRUARY 2011, AFRICA
• Q&A: What do you do with a captured pirate? 25 JANUARY 2011, AFRICA

Jo Dent, regional director of CQC for Yorkshire and Humber

York Hospital criticised over patient resuscitation

The hospital's own guidelines say do not attempt resuscitation forms should be updated regularly

York Hospital has been criticised for not asking relatives of some patients if they should be resuscitated.

The Care Quality Commission (CQC) said York Teaching Hospital NHS Trust had failed to meet its own guidelines.

It said Do Not Attempt Resuscitation (DNAR) forms should be updated regularly, with relatives' views taken into account.

The trust said it was "sorry" if any distress had been caused and it would "listen" to the CQC's recommendations.

Inspectors visited the York Hospital, St Helen's Rehabilitation Hospital and White Cross Court Rehabilitation Hospital in July 2011.

'Difficult topic'

They found that DNAR forms at York Hospital and St Helen's were not being completed correctly.

The documents were also not being reviewed as required by the hospital's own guidelines.

This meant that some patients may have had an instruction in place which was out of date, incorrect or no longer in their best interests, inspectors said.

Jo Dent, regional director of CQC for Yorkshire and Humber, said: "We found DNAR forms which had been completed by a doctor but that there was no evidence to say that patients had been involved in the decision, or evidence that relatives, even where they were taking an active role in the patient's progress, had been consulted."

She added: "Doctors we spoke to agreed it was best practice to discuss these decisions with the family or next-of-kin and the patient themselves, where possible.

"But one doctor also told us that it was a difficult topic to raise with relatives and patients and that these decisions were often made when relatives were not around."

'Best interests'

Patrick Crowley, chief executive at York Teaching Hospital NHS Foundation Trust said the trust was "disappointed to be found wanting in any area".

He said everyone within the organisation recognised the "importance and sensitivity" of discussions with patients and their families regarding DNAR decisions.

"We are aware of individual cases where patients and relatives have understandably found this difficult and we are sorry if this has caused any undue distress," he said.

"We want to listen to this feedback to help us develop our processes and ensure we demonstrate that we are acting in patients' best interests."

Mr Crowley added that a new system was introduced not long before the CQC's visit, and that the trust was continuing to roll that out across the organisation.

However, he added that while the CQC found "a small number" of concerns, the reports also highlighted "many examples" of good practice.

CQC has given the trust 28 days to provide a report that says what action they are going to take to address the problem.

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• Care Quality Commission
• York Teaching Hospital NHS Foundation Trust

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It is thought extensive use of sunscreen

The disease, caused by low levels of vitamin D generated in the body from sunshine and certain foods, had died out around 80 years ago but is now coming back.

Cases of rickets in children have occurred in northern England and Scotland where there are fewer months of the year with sufficient sunshine to obtain enough vitamin D but now doctors are seeing it on the South coast as well.

It is thought extensive use of sunscreen, children playing more time on computer games and TV rather than playing outside and a poor diet are to blame.

Professor Nicholas Clarke, consultant orthopaedic surgeon at Southampton General Hospital and professor of paediatric orthopaedic surgery at the University of Southampton, said: "The return of rickets in northern parts of the UK came as a surprise despite the colder climate and lower levels of sunshine in the north, but what has developed in Southampton is quite astonishing."

Children from all backgrounds are being affected now and the disease is not limited to the poor as it was in Victorian times.

Daily aspirin 'blocks bowel cancer'

Does and aspirin a day keep the cancer surgeon away?

A daily dose of aspirin should be given to people at high risk of bowel cancer, say scientists.

Two pills a day for two years reduced the incidence of bowel cancer by 63% in a group of 861 at-risk patients, a study reported in The Lancet said.
Newcastle University's Prof Sir John Burn, who led the study, said the evidence "seems overwhelmingly strong".
Other experts said the findings added to a growing body of proof that aspirin could be used in the fight on cancer.
The study was conducted on 861 patients with Lynch syndrome, which affects one in every 1,000 people.
They struggle to detect and repair damaged DNA which means they are more likely to develop a range of cancers including those of the bowel, womb and stomach.
'Good deal'
When looking at all patients in the trial, those in the group given 600 milligrams of aspirin every day developed 19 tumours compared to 34 tumours in the other "control" group, a reduction of 44%.

“Start Quote

People who've got a clear family history of, particularly, bowel cancer should seriously consider adding low dose aspirin to their routine and particularly those people who've got a genetic predisposition”

End Quote Prof Sir John Burn Newcastle University

When the researchers looked at just those patients who took the medication for at least two years the reduction was 63%.

There was also an effect on other cancers linked to Lynch syndrome, which fell by half in the treatment group.
Prof Sir John Burn, from Newcastle University, said there were 30,000 adults in the UK with Lynch syndrome.
If all were given the treatment he said it would prevent 10,000 cancers over 30 years and he speculated that this could possibly prevent 1,000 deaths from the disease.
However, there would also be side effects.
"If we can prevent 10,000 cancers in return for 1,000 ulcers and 100 strokes, in most people's minds that's a good deal," he said.
"People who've got a clear family history of, particularly, bowel cancer should seriously consider adding low dose aspirin to their routine and particularly those people who've got a genetic predisposition."
Aspirin is already well known to reduce the risk of heart attack and stroke in high risk patients.

Audrey Francis: walking time bomb

Audrey Francis describes herself as "a bit of a walking time bomb".
There is a history of cancer in her family and she has been diagnosed with Lynch syndrome.
Seventeen years ago she had a hysterectomy. That was when doctors discovered she had not one but two cancers - in the womb and the ovaries.
Tests showed she had a chunk of DNA missing which was causing the cancers: "I actually had the inability to stop the cancers developing," she said.
She took part in the trial and has since decided to self medicate with aspirin: "I've got my fingers crossed and I'm hoping it'll do the trick for me."

Other studies over the past two decades have suggested the pain killer reduced cancer risk, but this was the first randomised control trial, specifically for aspirin in cancer, to prove it.

In 2010, a study suggested patients given aspirin had a 25% lower risk of death during that trial.
Prof Peter Rothwell, from Oxford University, who conducted that study said the latest research "certainly helps to build a consistent picture, all pointing in the same direction that there is a link with cancer".
Cancer Research UK's Prof Chris Paraskeva said: "This adds to the growing body of evidence showing the importance of aspirin, and aspirin-like drugs, in the fight against cancer."
'Balanced argument'
One of the questions asked by the research into aspirin was whether healthy people with no family risks should take the drug.
The lower the risk of heart attack or cancer, the lower the benefit of taking aspirin, yet there are still potentially deadly side effects.
Sir John said that it was a "finely balanced argument" and that he decided the risks were worth it for him.
"I think where we're headed for is people that are in their 50s and 60s would look very seriously at adding a low dose aspirin to their daily routine because it's giving protection against cancer, heart attack and stroke.
"But if they do that they've got to have their eyes wide open. They will increase their risk of ulcers and gastrointestinal bleeds and very rarely they will have a stroke caused by the aspirin."

IVF linked to ovarian tumours

Fertility drugs are used to force the ovaries to produce eggs

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IVF has been linked to an increased risk of ovarian tumours in later life, according to a preliminary study.

Women given fertility drugs to produce eggs had more than triple the risk of an ovarian tumour that may turn cancerous, say Dutch researchers.

But the absolute risks are very low, they add.

A cancer charity said numbers involved in the study, published in the journal Human Reproduction, were too small to draw firm conclusions.

The study tracked more than 25,000 women attending IVF clinics in The Netherlands in the 80s and 90s.

Follow-up investigations revealed more cases than expected of ovarian tumours in women who had gone through IVF, which involves stimulating the ovaries to make eggs.

The biggest increase was in a type of growth, known as a borderline ovarian tumour, which can sometimes turn into cancer. It is less aggressive than other types of ovarian tumour, but requires surgery.

“Start Quote

Women should be informed about this but the risk should not be overstated”

End Quote Prof Flora van Leeuwen Netherlands Cancer Institute, Amsterdam

It normally affects around one in 1,000 women in the general population, but was found in about 3.5 in 1,000 women who had gone through IVF, say the researchers.

A smaller increase in other types of ovarian tumour was also found. Overall, ovarian cancer rates were twice as high among women who had gone through fertility treatment, the experts said.

Prof Flora van Leeuwen, a co-author of the study, told the BBC: "The absolute risk of these tumours is very low. But there is an increased risk of a borderline malignant tumour that needs surgery.

"Women should be informed about this but the risk should not be overstated."

Another co-author, Prof Curt Burger added: "The main message is that women who have had IVF shouldn't be alarmed. The incidence of ovarian cancer was extremely low."

'Reassuring'

Further research is planned to confirm the finding in a larger number of patients, and to look at whether some women are more at risk.

At present, the numbers involved are small. There were 61 women with ovarian tumours in the IVF treatment group; 31 had borderline ovarian tumours and 30 had ovarian cancer.

Continue reading the main story

Ovarian cancer

• Ovarian cancer is the 5th most common cancer in women in the UK
• Most cases are in women who are past the menopause
• Risk factors include a family history of cancer, being infertile or having fertility treatment, and smoking
• The symptoms of ovarian cancer can be very vague, particularly when the disease is in its early stages.
• Early symptoms can include pain in the lower abdomen or side, and/or a bloated, full feeling in the abdomen
• Source: Cancer Research UK

Commenting on the study, Prof Hani Gabra, of the Ovarian Cancer Action Research Centre at Imperial College London, said:

"Reassuringly, and in keeping with lots of previous research in this area, this study shows that the risks of invasive ovarian cancer are small in populations of patients receiving ovarian stimulation for IVF.

"Although this study shows that ovarian stimulation may increase the risk of much less aggressive borderline ovarian tumours, it underlines the fact that ovarian stimulation for IVF is not a major risk factor for invasive ovarian cancer."

Dr Claire Knight, senior health information officer at Cancer Research UK, said: "This interesting study suggests a possible link between ovarian stimulation for IVF and borderline ovarian tumours, but it certainly doesn't show that IVF causes invasive ovarian cancer.

"There were only a relatively small number of cases in this study, and the researchers didn't find that risk increased with the number of cycles a woman had, making conclusions hard to reach.

"Women can reduce their risk of ovarian cancer by being a non-smoker and keeping a healthy weight, and women who have taken the Pill or been pregnant are also at lower risk." Pill 'lowers ovarian cancer risk' Ovarian Cancer Action humrep.oxfordjournals.org

• Ovarian cancer risks and causes Cancer Research UK

XMRV in Chronic Fatigue Syndrome (CFS/ME) & Fibromyalgia

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Myalgic encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS), and Fibromyalgia (FM) are debilitating illnesses which have no cure and can leave sufferers' lives in ruins. Even those best able to adapt and cope often suffer with well-meaning people who think the illnesses was somehow brought upon themselves, or that the illnesses doesn't really exist. This site was set up following a study, in October 2009, that suggested ME/CFS (and possibly Fibromyalgia) might be caused by a retrovirus called XMRV. XMRV study in Science The study was published in the journal Science and found the retrovirus XMRV (xenotropic murine leukemia virus-related virus) in 67% of patients with ME/CFS. Only 3.7% of the healthy controls studied had this infection. Later, the researchers reported up to 95% of patients test positive for XMRV with antibody testing. Lack of understanding about the causes of ME / CFS Lack of understanding about the causes of ME / CFS and the lack of any effective treatments can often lead to patients trying, out of desperation, unproven and unscientific remedies. The discovery of the XMRV retrovirus led people to ask whether this virus is a possible cause of CFS. News of the discovery prompted much needed discussion and a focus on the plight of CFS patients; it gives their illness a long-overdue legitimacy. For many years CFS/ ME went unrecognised as a genuine medical condition. Many doctors say that it has a psychological as well as a physical basis, but few believed it is caused solely by a viral infection. The Whittemore Peterson Institute (the group behind the research) was founded by Annette Whittemore, whose daughter suffers from ME. This privately funded, not for profit, organisation has finally put ME/ CFS and Fibromyalgia on the media agenda. It may transpire that XMRV is behind a string of illnesses referred to variously as CFS, ME, Fibromyalgia, Atypical Multiple Sclerosis, Chronic Mononucleosis. Scientists are already using the term XAND, for XMRV Associated Neuroimmune Disease. Attempts to replicate the findings of the WPI Since the study appeared, several groups have tried to replicate the findings of Dr. Judy Mikovits (Whittemore Peterson Institute). Two groups in Britain and one in the Netherlands have published studies showing no links to the virus, and three other groups, two in the US and one in Europe, have reported negative findings at conferences. Most recently a second research team has reported a link between CFS and the same class of virus, a category known as MLV-related viruses. In a paper published in August 2010 by PNAS, scientists found evidence of several MLV-related viruses in blood cells 86.5% of chronic-fatigue patients but only 6.8% of healthy ones. The researchers did not find XMRV. However, XMRV is itself is a MLV-related virus and the author of the PNAS study has stated that this latest research supports the initial study that discovered XMRV in CFS blood samples. The emerging research has caught the attention of the blood bank industry. Canada recently began banning people with chronic fatigue syndrome from donating blood over concerns about possible XMRV transmission. The American Association of Blood Banks also issued a similar recommendation in June 2010

Elderly dignity charter launch by Wrexham care groups

The charter aims to promote a 'zero tolerance' of 'abuse and disrespect' for elderly people in care

• Elderly 'neglect culture in NHS'
• 'Shameful' care of older patients

A range of social and health groups in Wrexham have launched a charter aimed at providing older people with dignity as they have medical or social care.

The charter aims to promote a zero tolerance "of abuse and disrespect" for older people by staff and volunteers.
Wrexham council is leading the drive, which also includes professional and charity groups.
Wales' public services ombudsman has said a culture of neglect was failing frail and elderly hospital patients.
Peter Tyndall's comments last week came after older people's commissioner Ruth Marks said some care was "shamefully inadequate".
Wrexham council's launch of the Older Peoples Dignity in Care Charter for Wrexham is part of a national campaign to improve the quality of care and highlight the experiences of service users.
Andrew Figiel, the local authority's chief social care officer, said: "This charter is at the heart of what we do.

“Start Quote

Dignity in care is a fundamental principle in the provision of the services we deliver”

End Quote Andrew Figiel Wrexham council

Society's attitude

"Dignity in care is a fundamental principle in the provision of the services we deliver."

Other groups signed up include Betsi Cadwaladr University Health Board, the Association of Voluntary Organisations in Wrexham, Age Concern North East Wales and British Red Cross.
Meanwhile, Age Cymru was holding a conference in Wrexham on tackling society's attitude to age and ageing.
Dr Ceri Cryer, the charity's Growing Older in Wales programme manager, said: "The population of Wales is ageing - one-in-four Welsh adults are aged 65 or over, and in 20 years' time one-in-three Welsh adults will be aged 65 or over.
"Clearly we need to adapt to the needs of our ageing population and tackling ageism and age discrimination is an important part of this process."

More on This Story

Related Stories

• Elderly 'neglect culture in NHS' 15 MARCH 2011, WALES
• 'Shameful' care of older patients 14 MARCH 2011, WALES

Related Internet links

• Older People's Commissioner for Wales
• The Patients Association
• Public ombudsman for Wales