Tuesday, 18 October 2011

Better hospital IT 'would save thousands of lives'

Monday, 17 October 2011

Better hospital IT 'would save thousands of lives'

Medication errors were halved by using the IT system, the report authors say

Better use of information technology in England's hospitals could help prevent 16,000 deaths a year, a report says.

University Hospitals Birmingham has recommended its system to the team investigating above-average death rates from 2005 to 2008 at Stafford Hospital.

The trust says it saw a 17% fall in deaths among emergency patients over 12 months, which would equate to 16,000 deaths prevented across England.

Systems include a computer reminding staff to give patients their drugs.

The trust says IT surveillance on its wards is backed up by a policy of holding staff to account for errors.

The report shows how the trust has harnessed IT to bear down on errors, with the initial focus on preventing missed medications. Evidence suggests that hospitals may miss one dose in every five.

Staff at the trust are issued with computer-generated reminders, and the system also issues warnings to prevent prescriptions which could harm the patient.

The number of medication errors at the trust has halved, which has coincided with a sharp fall in deaths for patients admitted as an emergency, the report says.

Missed medications are just one of many clinical activities that are monitored on University Hospitals Birmingham's computer database, and presented to staff on the wards on a dashboard display.

It also includes falls, checks for blood-clots and infection control.

The system also generates alarms when staff key-in clinical information that could give cause for concern, such as changes to a patient's temperature, heart rate, or blood pressure. This triggers an alert in the critical care Unit, prompting an outreach team to be dispatched to wherever they are needed in the hospital.

Where mistakes arise, the real-time feedback to senior executives enables them to call staff to account, with regular reviews to assess and explain performance.

'Culture change'

The trust's medical director, Dr Dave Rosser, said nurses in modern healthcare have trained and worked in an environment where one in five drugs is not given and that this has become the norm.

"It has become over the decades culturally acceptable for drugs not to be given to patients, and what we've been trying to do here is turn round that culture and say every single dose is important."

Dr Rosser was asked to present a report to the public inquiry into the Mid Staffordshire NHS scandal. The paper shows that mortality rates for patients admitted as an emergency fell by nearly 17% over a 12-month period, but remained static in the rest of England. He said that if his trust's approach was adopted across the NHS, this would equate to 16,000 deaths avoided.

The matron in the critical care unit at the Birmingham trust's Queen Elizabeth hospital, Helen Gyves, said nurses recognised the value of tight clinical scrutiny.

"All of the ITU nurses work in a hi-tech environment so they are used to the impact of IT. So if you asked us why we hadn't done something or if you can give us evidence to prove that by challenging us things will improve for the patient, then we wouldn't mind."

The matron in the hospital's clinical decision unit, Liz Miller, said increased accountability had improved the culture of care.

"A good nurse ensures that all of the care is given to the patient. Not just the medication, not just the fluid, but also the personal hygiene, those nursing touches, the communication with the patients. How well she gives her medication and how on time she gives her medication is a good barometer of the all-round care that she gives."

The system at University Hospitals Birmingham is one of several commercially available to the NHS. The chief executive of the Patients Association, Katherine Murphy, welcomed the work at the trust.

"This system has the potential to really make a big difference to patient safety across the board. By highlighting ongoing problems and trends in patient care, ward and trust leaders can put changes in place to prevent other patients from suffering in the same way, learning from their mistakes rather than trying to bury them under bureaucracy."

Monday, 17 October 2011

Black Death genetic code 'built'

The ancient burial site is under what is now the Royal Mint

The genetic code of the germ that caused the Black Death has been reconstructed by scientists for the first time.

The researchers extracted DNA fragments of the ancient bacterium from the teeth of medieval corpses found in London.

They say the pathogen is the ancestor of all modern plagues.
The research, published in the journal Nature, suggests the 14th Century outbreak was also the first plague pandemic in history.
Humans have rarely encountered an enemy as devastating as the bacterium, Yersinia pestis. Between 1347 and 1351 it sparked the Black Death, an infection carried by fleas that spread rapidly across Europe killing around 50 million people.
Now scientists have uncovered some of the genetic secrets of the plague, thanks to DNA fragments drilled from the teeth of victims buried in a graveyard in London's East Smithfield.
Professor Johannes Krause from the University of Tubingen, Germany, was a member of the research team. He said all current strains circulating in the world are directly related to the medieval bacterium.

The plague

The plague is one of the oldest identifiable diseases known to man
Plague is spread from one rodent to another by fleas, and to humans either by the bite of infected fleas or when handling infected hosts
Recent outbreaks have shown that plague may reappear in areas that have long been free of the disease
Plague can be treated with antibiotics such as streptomycin and tetracycline
Source: World Health Organization

"It turns out that this ancient Yersinia pestis strain is very close to the common ancestor of all modern strains that can infect humans," he said.

"It's the grandmother of all plague that's around today."
Previously researchers had assumed the Black Death was another in a long line of plague outbreaks dating back to ancient Greece and Rome.
The Justinian Plague that broke out in the 6th Century was estimated to have killed 100 million people. But the new research indicates that plagues like the Justinian weren't caused by the same agent as the medieval epidemic.
"It suggests they were either caused by a Yersinia pestis strain that is completely extinct and it didn't leave any descendants which are still around today or it was caused by a different pathogen that we have no information about yet," said Professor Krause.
Tooth power
Globally the infection still kills 2,000 people a year. But it presents much less of a threat now than in the 14th Century.

DNA fragments were extracted from teeth

According to another member of the research team, Dr Hendrik Poinar, a combination of factors enhanced the virulence of the medieval outbreak.
"We are looking at many different factors that affected this pandemic, the virulence of the pathogen, co-circulating pathogens, and the climate which we know was beginning to dip - it got very cold very wet very quickly - this constellation resulted in the ultimate Black Death."
Rebuilding the genetic code of the bacterium from DNA fragments was not easy, say the scientists.
They removed teeth from skeletons found in an ancient graveyard in London located under what is now the Royal Mint.
Dr Kirsten Bos from McMaster University explained how the process worked.
"If you actually crack open an ancient tooth you see this dark black powdery material and that's very likely to be dried up blood and other biological tissues.
"So what I did was I opened the tooth and opened the pulp chamber and with a drill bit made one pass through and I took out only about 30 milligrams of material, a very very small amount and that's the material I used to do the DNA work."
From the dental pulp the researchers were able to purify and enrich the pathogen's DNA, and exclude material from human and fungal sources.
The researchers believe the techniques they have developed in this work can be used to study the genomes of many other ancient pathogens.

light on autism

Low birthweight 'linked to autism', says US study

Babies born underweight are known to be prone to a variety of cognitive problems.

Babies born weighing less than 4lb (1.8kg) could be more prone to developing autism than children born at normal weight, a study suggests.

Writing in Pediatrics journal, US researchers followed 862 New Jersey children born at a low birthweight from birth to the age of 21.
Some 5% were diagnosed with autism, compared to 1% of the general population.
But experts say more research is needed to confirm and understand the link.
Links between low birthweight and a range of motor and cognitive problems have been well established by previous research.
But the researchers say this is the first study to establish that these children may also have a greater risk of developing autism spectrum disorders.
The babies in the study were born between September 1984 and July 1987 in three counties in New Jersey.
They all weighed between 0.5kg and 2kg or a maximum of about 4.4lb.
At the age of 16, 623 children were screened for risk of an autism spectrum disorder (ASD).

“Start Quote

Most low birthweight children don't have autism, and most children with autism don't have low birthweight.”

End Quote Prof Dorothy Bishop University of Oxford

Of the 117 who were found to be positive in that screening, 70 were assessed again at age 21.

Eleven of that group were found to have an autism spectrum disorder.
From these results, the researchers calculated an estimated prevalence rate of ASD of 31 out of 623 children, which is equal to 5%.
Jennifer Pinto-Martin, professor at the University of Pennsylvania School of Nursing and director of the autism centre where this research was conducted, said: "Cognitive problems in these children may mask underlying autism.
"If there is suspicion of autism or a positive screening test for ASD, parents should seek an evaluation for an ASD. Early intervention improves long-term outcome and can help these children both at school and at home."
Dig deeper
But Dorothy Bishop, professor of developmental neuropsychology at the University of Oxford, said it was important to put the findings in perspective.
"The association looks real, but nevertheless, most low birthweight children don't have autism, and most children with autism don't have low birthweight."
Georgina Gomez, action research leader for The National Autistic Society, said more research is needed to confirm the link between low birthweight and autism and better understand why babies born underweight may be more prone to developing autism.
"Low birthweight has been linked to a range of motor and cognitive problems and often goes hand-in-hand with premature birth and birthing complications.
"It is important to dig down further to try to understand the biological processes and events that could explain this proposed connection."

Trees 'boost African crop yields and food security'

Trees 'boost African crop yields and food security'
The nitrogen-fixing roots of certain trees provide valuable nutrients to resource-poor arable land
Related Stories
How Africa 'can feed itself'

Trees: More than just carbon sinks

Trees are 'crucial famine food'

Planting trees that improve soil quality can help boost crop yields for African farmers, an assessment shows.
Fertiliser tree systems (FTS) also help boost food security and play a role in "climate proofing" the region's arable land, the paper adds.
Researchers from the World Agroforestry Centre say poor soil fertility is one of the main obstacles to improving food production in Africa.
The results appear in the International Journal of Agricultural Sustainability.
"In Africa, it is generally agreed that poor soil management - along with poor water management - is most greatly affecting yields," explained co-author Frank Place, head of the centre's Impact Assessment team.
He said that despite chemical fertilisers having been on the market for more than half a century, farmers appeared reluctant or unable to buy them.
"Therefore, there have been a lot of attempts to bring in other types of nutrients from other systems - such as livestock and plants" he told BBC News.
"We have been working quite a lot on what is broadly referred to as 'fertiliser tree systems'."
Although it has been known for centuries that certain plants, such as legumes, "fix" nitrogen in the soil and boost food crop yields, Dr Place said that the centre's researchers had been looking to develop a more active management approach such as FTS.
Continue reading the main story

“Start Quote
In TFS across Africa as a whole, yields are doubling or more in two-thirds of cases”
End Quote Frank Place WAC
"Some farms, for example in Zambia, where the farms are larger, it is possible to rest arable land and allow it to lie fallow," he observed.
"But in place such as much of Malawi, where population densities are higher, they cannot afford to fallow their land; so we came up with alternative management systems where they could intercrop the trees with the (maize)."
While the technique is not new, Dr Place said that some of the nitrogen-fixing species used by farmers were probably not the most effective.
For example, farmers in East Africa had been using Cajanus cajan (also known as pigeon pea).
"A lot of the nitrogen was being stored in the trees' seeds; so there was an effort to use other trees that put a greater volume in the soil, such as Gliricidia sepium (one of its common name is mother of cocoa)," he said.
"A really nice thing about G. sepium is that we have been coppicing some of those trees for 20 years and they still continue to grow back vigorously."
Continue reading the main story

What is 'nitrogen-fixing'?
The atmosphere consists of about 80% nitrogen, but plants cannot use it in this form

Certain plants, such as legumes, have bacteria growing in their root hairs that convert it into a form that plants can use

This form of nitrogen is know as "green manure" and is a nutrient that helps plants, such as food crops, to grow

(Source: World Agroforestry Centre)
However, he acknowledged that there were a number of challenges that had to be addressed in order to maximise yields.
For example, some systems suggested planting rows of trees between rows of crops with mixed results.
"We realised that there were a few management problems with that sort of system - what tended to happen was that there was too much competition between the crops and the trees," Dr Place explained.
"We developed a new management system where the trees were cut very low to the ground at the time you are planting the crop so then there was no light competition.
"The trees go into a dormant state when you cut them like this, so the root system is not competing straight away for the nutrients, so the maize is free to become established.
"The trees only really start to come out out of the dormant phase when the maize is already tall."
Another challenge was to provide enough seeds in order to have mass-scale planting. He said that balancing the provision of high-quality seeds with large local engagement was another hurdle that had to be overcome.
But the rewards in improved yields were noticeable, he added.
"Some of the studies have shown that in TFS across Africa as a whole, yields are doubling or more in two-thirds of cases."
Where the systems were not delivering such good results, Dr Place said that scientists were looking to refine current practices and modify them to suit the local conditions.
'Climate proofing'
As well as helping to boost yields, the use of trees in agriculture has other benefits - such as helping to "climate proof" agriculture land.
One example, Dr Place said, was the use of Faidherbia albida (common names include winter thorn and apple-ring acacia) in West African arable landscapes.
"It has a deep penetrating tap root, and it can secure a good water supply even in dry years," he explained.
"Generally speaking, tree roots do go much deeper than crop roots, so it is recycling nutrients and water from deeper reaches.
"There are also studies showing that these roots act as conduits and bring up water to surface root systems (such as those belonging to crops)."
The editor-in-chief of the International Journal of Agricultural Sustainability, Professor Jules Pretty from Essex University in , said the study illustrated that there was a growing movement of agricultural innovations across Africa that were increasing yields and at the same time improving the environment.
"Trees and shrubs in agricultural systems seem to break some of the rules of agriculture - in this case, farmers are using shrubs to create a diverse rotation pattern rather than year-on-year maize," he told BBC News.
"The trees fix nitrogen and improve the soil; the leaves can be fed to livestock; the crops then benefit greatly in subsequent years."

Saturday, 15 October 2011

A painkiller taken by millions can increase the risk of heart attack and stroke

A painkiller taken by millions can increase the risk of heart attack and stroke by 40%, the Daily Mail has today reported. The newspaper says that researchers are calling for the drug, called diclofenac, to be available on prescription only.

The news is based on a large review that looked at the cardiovascular risks associated with a class of widely used painkillers called non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs in high-dose formulations are usually only available on prescription, but some low-dose NSAIDs, including ibuprofen, naproxen and diclofenac, can be bought over the counter.

The review found that diclofenac raised the risk of heart problems by 22% when taken at over-the-counter doses and by 40% at prescription strength. Naproxen and low-dose ibuprofen were least likely to increase the risk of heart attacks and strokes.

While previous research has highlighted the cardiovascular risks of some NSAIDs, this review of observational studies provides some important new information about the risks associated with all currently available NSAIDs at different doses. As such, its findings will no doubt be important to future decisions about how these drugs should be used and regulated.

However, it is important to note that for a healthy individual who takes diclofenac, the increased risk to the heart is still very small. The nature of this research means it is not possible to estimate accurately how small this risk is. Anyone who is concerned about taking NSAIDs should not stop taking these drugs but should consult their doctor.

Where did the story come from?

The study was carried out by researchers affiliated with Hull York Medical School, the Institute for Clinical Evaluative Sciences, the University of Toronto in Canada and the University of Newcastle in Australia. It received no external funding. The study was published in the peer-reviewed journal PLoS Medicine.

The research was covered fairly in most newspapers. In its print version of the story the Daily Mail featured a large front-page headline warning of a “Painkiller heart alert”, which may have been alarming. However, within the article itself the Daily Mail did feature prominent messages that patients should not panic and should not stop taking their medication. Both the Daily Mail and The Daily Telegraph reported that, for most healthy people, the increased risk of heart and other problems from diclofenac was small, and the reports featured in the Daily Mail, The Daily Telegraph and the Daily Express all included comments and advice from independent experts.

What kind of research was this?

This was a systematic review comparing the risks of individual NSAIDs taken at typical doses by people at home, rather than in hospital. The researchers say that there are concerns about the risk associated with non-prescription NSAIDs available in low-dose forms, such as ibuprofen, naproxen and diclofenac.

The researchers point out that while some randomised trials have highlighted the cardiovascular risk of some NSAIDs, little is known about how the risks of individual drugs compare when used at different doses, for different lengths of time and in different populations. For this reason the researchers set out to examine the outcomes seen in controlled observational studies, which would better reflect the risks associated with the typical domestic use of NSAIDs rather than the risks associated with their use in the idealised setting of a clinical trial. To date, randomised trials of NSAIDs have reported only small numbers of heart and stroke problems.

What did the research involve?

The researchers searched a wide range of electronic databases for relevant studies published between 1985 and 2010 that had reported on the cardiovascular risks associated with the use of individual NSAIDs in population settings. They included only non-randomised, controlled observational studies in their literature search. These observational studies included case control, cohorts and case-crossover studies. They then assessed the methodological quality of the selected studies. From a total 459 potentially relevant papers, 51 studies met their criteria.

From the studies gathered, the researchers extracted and pooled information about the risk of major cardiovascular events associated with individual NSAIDs. They also assessed subsets of studies that provided relevant information to examine the risk of NSAIDs in different doses and in people with low and high existing risk of heart problems. To compare different drugs they carried out a further type of analysis, called a pair-wise comparison, where they indirectly compared each drug against another in turn, taking the results from separate trials.

The overall analyses included data from 30 case-control studies and 21 cohort studies involving more than 2.7 million individuals and featuring a total of 184,946 cardiovascular events.

What were the basic results?

The researchers looked at the drugs where there were 10 or more studies. Of drugs where there were 10 or more studies, researchers found that the highest overall risks were seen with rofecoxib and diclofenac, and the lowest with ibuprofen and naproxen. Compared with not using any NSAIDs, the researchers found:

rofecoxib increased the risk of heart problems by 45% (95% CI 1.33 to 1.59)
diclofenac increased the risk by 40% (95% CI 1.27 to 1.55)
ibuprofen increased the risk by 18% (95% CI 1.11 to 1.25)

In a subset of studies that looked at risk associated with lower doses they found:

low doses of rofecoxib increased the risk by 37% (95% CI 1.20 to 1.57)
low doses of celecoxib increased the risk by 26% (95% CI 1.09 to 1.47)
low doses of diclofenac increased the risk by 22% (95% CI 1.12 to 1.33)

It is important to note that the drug rofecoxib has already been withdrawn from the market because of its association with a raised risk of cardiovascular events. Including it in the study allows the risk associated with other drugs to be compared with the risks of rofecoxib.

Ibuprofen only posed a risk when taken at a higher dose and naproxen had no significant risk at any dose.

The researchers say the increase in risk was proportional for both high- and low-risk groups. This means that, relative to their risk if not using NSAIDS, the risks for both groups increased to the same extent. The risk of cardiovascular problems also rose early in the course of treatment. For some NSAIDs, risk was found to increase within the first month of taking the drug.

How did the researchers interpret the results?

The researchers say the results of their review “are robust enough to inform clinical and regulatory decisions”.

They call for “regulatory action” on diclofenac, as it is currently available without prescription.
They say the limited data on etoricoxib “raises serious concerns” about safety, particularly as similar drugs such as rofecoxib have been withdrawn.
They say that, in the case of ibuprofen, labelling warnings should be strengthened to stop patients who are already at high risk of cardiovascular problems from exceeding the maximum recommended dose.
They question the continued use of indomethacin.

Conclusion

This large review has published some important information on the cardiovascular risks associated with NSAIDs, including the risk associated with different doses and in populations at both high and low risk of cardiovascular events. It raises concerns about some of these risks, in particular the risk associated with the widely used non-prescription drug diclofenac.

As its authors point out, it had some limitations.

It had to rely on observational studies (rather than randomised controlled trials), which are subject to bias, especially in terms of other factors (confounders) that might influence results. However, the researchers did take steps to minimise this risk.
The data in the studies mainly came from large administrative databases and electronic health records, and may not have been comprehensive, especially concerning key information such as use of non-prescription NSAIDs and aspirin, or information about people’s risk of heart problems.
The review suffered from ‘heterogeneity’. This means that many of the studies varied in their design, their methods and how they analysed results. Heterogeneity makes it harder to combine the results of different studies accurately and can, therefore, throw doubt on the findings of systematic reviews.

Patients using NSAIDs who are worried about side effects should not stop taking them, but instead consult their doctor.

Links To The Headlines

Painkiller heart alert: Don't stop taking pills, but do talk to your GP, British scientists urge. Daily Mail, September 28 2011

Common painkillers can raise heart risk. The Daily Telegraph, September 28 2011

Health alert over common painkiller. Daily Express, September 28 2011

Links To Science

McGettigan P, Henry D. Cardiovascular Risk with Non-Steroidal Anti-Inflammatory Drugs: Systematic Review of Population-Based Controlled Observational Studies. PLoS Medicine 8(9)

Stromatolite colony found in Giant's Causeway

The discovery was made at the Giant's Causeway

In a small grey puddle tucked into a corner of the world famous Giant's Causeway, scientists have made an extraordinary find.

A colony of stromatolites - tiny structures made by primitive blue-green algae.

Stromatolites are the oldest known fossils in the world.

The tiny algae or bacteria that build them are also thought to be the most ancient life form that is still around today, after more than three billion years.

What makes the discovery in Northern Ireland so remarkable is that until now these structures have been found mainly in warm and often hyper saline waters which discourage predators.

The stromatolites in the Giant's Causeway are in a tiny brackish pool, exposed to the violence of waves and easy prey to the animals that are already living amongst them.

Stromatolites are formed by blue-green algae that excrete carbonate to form a dome-like structure. Over thousands of years these build up into a hard rock that continues to grow.

Stromatolite fossils have been dated as far back as three and a half billion years.

The colony at the Giant's Causeway on Northern Ireland's wind-swept north coast was found by accident.

Scientists from the School of Environmental Sciences at the nearby University of Ulster were looking for very different geological formations when Professor Andrew Cooper spotted the stromatolites.

'Puzzling'

"I was very surprised", explained Professor Cooper.

"I was walking along with a colleague looking at something else. Out of the corner of my eye I spotted these structures which, had I not seen them before in my work in South Africa, I probably wouldn't have known what they were."

The colony is very young, just a layer thick, so it's recently formed. One thing that is puzzling scientists is why its chosen this spot.

"There is some unusual set of circumstances that occurs just here that doesn't occur even 10 metres away along the beach," said Professor Cooper.

"So whatever it is, it's very special to this particular time and space."

One clue could be the myriad of shells in the grass banks just about the tiny pool. Rain water is leaching through the ground and the shells, dissolving out calcium carbonate and carrying to the stromatolites.

Stromatolites' appearance on this planet is seen as a turning point in the earth's evolution

The blue-green algae that form the stromatolites helped create our present atmosphere by breaking down carbon dioxide and excreting oxygen. Their appearance on this planet is seen as a turning point in the earth's evolution.

While living examples are thought to be rare, it could be that we haven't found them because we aren't looking for them.

"The chances are that they may be more widespread than we actually know", explained Professor Cooper.

"Geologists have spent a lot more time studying the ancient stromatolites that are two billion years old than we have spent on living stromatolites.

"So this is an important site where we can look at the circumstances in which stromatolites actually occur."

News of the find is only starting to leak out but its expected to start a frenzied search around the coast of Ireland to see if there is more of this primitive organism to be discovered.

Friday, 14 October 2011

“Eating just three eggs a week increases chance of men getting prostate cancer,”

The men who ate the most eggs were at a higher risk

“Eating just three eggs a week increases chance of men getting prostate cancer,” reported the Daily Mail. The story went on to say: “Experts in the US claimed that men who consume more than two-and-a-half eggs on a weekly basis were up to 81% more likely to be killed by the disease.”
This research examined the association between eating red meat, poultry and eggs and the risk of developing lethal prostate cancer (which the researchers defined as either dying from the disease or having metastatic disease that had spread to other organs). The study was in a large group of 27,607 healthy men, of whom 199 developed lethal prostate cancer over 14 years of follow-up. The researchers calculated that the men who ate the most eggs were at a significantly higher risk than those who ate fewer eggs. No significant association was found with any other food item.
This large cohort study has some strengths, such as its large size and the fact that information on the participants’ diet was continually updated over the course of the study. However it also has several limitations, and only a small number of lethal cancers actually occurred, which could suggest that this association is due to chance. Furthermore, these results are inconsistent with previous research, which found no significant association between eggs and prostate cancer. The findings will need to be confirmed in more robust studies before any firm conclusions can be drawn.

Where did the story come from?

The study was carried out by researchers from the Harvard School of Public Health, the University of California in San Francisco, Brigham and Women’s Hospital and Harvard Medical School. Funding was provided by the US National Institute of Health.
The study was published in the peer-reviewed medical journal, Cancer Prevention Research.
The media generally reported the study accurately. However, the Daily Mirror’s suggestion that “a clear link between eggs and prostate cancer” has been found may be misleading, as the researchers say that their results contradict previous findings into the association and that more research is needed. But the Mirror does point out that men in the study who ate the most eggs differed from the rest of the participants in important ways, such as weight and smoking status.

What kind of research was this?

This was a prospective cohort study that investigated whether there is an association between eating red meat, poultry and eggs and the risk of developing lethal prostate cancer in healthy men. A subgroup analysis was carried out afterwards in the men from this cohort who went on to develop prostate cancer. The researchers wanted to see whether eating habits after a prostate cancer diagnosis were associated with the risk of the disease progressing and becoming fatal.
The researchers’ theory was based on the findings from previous research, which found:

an increased risk of developing lethal prostate cancer in healthy men who ate red meat
an increased risk of progression to lethal disease in men with prostate cancer who ate eggs and skin-on poultry after their diagnosis

Participants were recruited from an ongoing cohort study that began in 1986. This study was comprised of American male health professionals who were between the ages of 40 and 75 in 1986. Men in this study completed a questionnaire every two years with information on their medical conditions, physical activity, weight, medications and smoking status. They provided information regarding their eating habits every four years.
Prospective cohort studies are an appropriate design for answering this type of research question. Assessing eating habits at the beginning of a study reduces the risk that people will inaccurately recall their dietary habits, which can arise when you ask people to remember what they ate over a long period of time. It also ensures that the exposure (eating certain foods) precedes the outcome (developing and dying of prostate cancer).

What did the research involve?

In 1994, the researchers recruited 27,607 men from the existing cohort study in the US. The men did not have prostate or other forms of cancer (except non-melanoma skin cancers, which are rarely aggressove). They had also had a prostate specific antigen (PSA) test (PSA screening is not performed in the UK, as higher PSA levels can indicate cancer but are not specific for it. For example, raised levels can also occur with benign enlargement, infection or inflammation).
In this study:

Information on the men’s eating habits was collected every four years.
Information regarding prostate cancer diagnosis was collected every two years.
From men who had been diagnosed with prostate cancer, information of treatment and disease progression was collected every two years.

The researchers defined lethal prostate cancer as disease that had spread to distant organs (metastatic cancer) or death due to prostate cancer during the study’s follow-up period (1994 to 2008).
The researchers followed up the cohort for 14 years and analysed the associations between eating different amounts of red meat, poultry and eggs and the risk of developing lethal prostate cancer. The researchers grouped each participant according to the average amounts of each type of food they ate per week. For red meat, the subgroups included (per week):

less than three servings
3 to 4 servings
5 to 7 servings
over 8 servings

For poultry, the subgroups were defined as (per week):

less than 1.5 servings
1.5 to 2.5 servings
2.5 to 3.5 servings
over 3.5 servings for week

For eggs, the subgroups were:

less than half an egg
0.5 to 1.5 eggs
1.5 to 2.5 eggs
over 2.5 eggs

To determine which subgroup each participant would be allocated to, the researchers averaged their responses from all of the dietary questionnaires the participants had completed up until their diagnosis, or until the end of the study (for those who were not diagnosed).
To determine the amount of each food eaten, the researchers averaged the reported amounts over all of the questionnaires that were completed before diagnosis. During the analysis, the researchers controlled for possible confounding factors such as age, amount of food eaten, body mass index (BMI, which is an indicator of obesity), smoking status and physical activity levels.
The researchers also analysed the risk of dying from prostate cancer in the men who were diagnosed with it during the course of the study, based on their eating habits after diagnosis. The researchers only included men who were diagnosed with localised cancer (cancer that had not spread beyond the prostate). During the analysis, they controlled for possible confounding factors such as age at diagnosis, time since diagnosis, disease stage, treatment type, BMI, activity level, smoking status and pre-diagnosis diet.

What were the basic results?

Of the 27,607 men included, 199 died of prostate cancer during the study. When the researchers analysed the association between eating habits and risk of lethal prostate cancer when using data up to the point of initial diagnosis, they found that:

Men who ate an average of 2.5 or more eggs per week had an 81% higher risk of lethal prostate cancer compared to those who ate an average of less than half an egg per week (Hazard Ratio [HR] 1.81, 95% CI 1.13 to 2.89, p=0.01).
The association between average amount of eggs eaten per week and risk of lethal prostate cancer became non-significant when the researchers analysed data collected up to the point of development of a lethal form of the disease (that is, disease progression or death).
There was no significant association between the average amount of red meat eaten and the risk of lethal prostate cancer.
Men who consumed more red meat or eggs tended to exercise less and have a higher BMI, and were more likely to smoke and have a family history of prostate cancer.

Of the 3,127 men who developed prostate cancer during the course of the study, 123 died of it during follow-up. Further analysis of the men who died found no significant association between eating habits after diagnosis and risk of the disease progressing from localised prostate cancer to lethal prostate cancer.

How did the researchers interpret the results?

The researchers conclude that: “Eating eggs may increase risk of developing a lethal form of prostate cancer among healthy men,” and that although “additional large prospective studies are needed, caution in egg intake may be warranted for adult men”.

Conclusion

This was a large prospective cohort study that examined the impact of lifestyle on the risk of developing and dying of advanced prostate cancer.
In addition to its large size, another strength of the study is that the information regarding exposure (eating habits) and possible confounders (medical conditions, activity levels, weight, medications and smoking status) were continually updated over the study’s course. However, updating information on eating habits every four years may still introduce a significant level of recall bias, and accurately remembering what you ate over the previous four years is likely to be difficult.
The study and data analysis also has several limitations. First, the number of deaths and cases of lethal prostate cancer were small (only 199 out of 27,607 men in the whole cohort, and 123 out of 3,127 in the case-only cohort [those who initially developed localised disease]). This small number increases the likelihood that the results are due to chance. Second, the researchers say that the group of men included in the study generally ate low amounts of the foods of interest, which limits the “power” (or ability to detect a difference) of the analysis.
Furthermore, while the researchers controlled statistically for a number of possible confounders, it is difficult to say whether other factors could account for this relationship. The researchers say that men in the study who consumed more red meat or eggs tended to have a higher BMI, exercise less and were more likely to smoke and have a family history of prostate cancer. Additionally, it is probably difficult to control completely for other dietary effects and focus the analysis on a single component of a person’s diet.
This study points to possible associations between diet and risk of prostate cancer. The aforementioned limitations, however, weaken the strength of these conclusions, along with the fact that previous research has looked at this question and found no association. While an 81% increased risk sounds like a high and definitive figure, it is probably best to wait for more conclusive research before cutting eggs out of your diet. There are existing dietary and lifestyle guidelines for reducing cancer risk, such as limiting your consumption of energy-dense foods such as meat and increasing your consumption of fruits, vegetables and wholegrains.

Links to the headlines

Eating just three eggs a week ‘increases chance of men getting prostate cancer’. Daily Mail, September 30 2011
Prostate cancer linked to eggs, say researchers. Daily Mirror, September 30 2011
Just 3 eggs a week ‘raises the prostate cancer risk’. Daily Express, September 30 2011

Links to the science

Richman EL, Kenfield SA, Stampfer MJ et al. Egg, red meat, and poultry intake and risk of lethal prostate cancer in the prostate specific antigen-era: incidence and survival. Cancer Prevention Research, Published Online First September 19 2011

Badger vaccine pilot planned by National Trust in Devon

A decision to cull badgers could prove to be as controversial as selling off nationally owned forests

The National Trust is to vaccinate badgers against TB this summer in a bid to curb the disease in cattle - the first UK landowner to do so.

The trust hopes its £320,000, four-year project on Devon's Killerton estate will make the case for vaccination as an alternative to culling.
Cattle (or bovine) tuberculosis costs the UK about £100m each year.
The government is set to approve badger culling in England soon, and the Welsh Assembly Government also plans a cull.
Research published last year showed the vaccine lowers infection in badgers.
Some cattle herds contract TB through contact with badgers, which carry the bacterium, although infection from other cattle is more significant.
Badger culling is a controversial option and although the trust is not opposed to it in principle, it is troubled by research showing it could do more harm than good - hence the vaccination scheme.
"This is a pilot project - it's not research, not a trial - we know the vaccine works, and we're going for it," said David Bullock, the trust's head of nature conservation.
"The driver is that we want to reduce the risk of bovine TB breakdowns in cattle herds belonging to our tenant farmers, 18 of whom are involved in this project - and we also want to see that the vaccine is considered nationwide."
Last December, scientists with the government-owned Food and Environment Research Agency (Fera) published the results of a four-year field trial using an injectable TB vaccine.

“Start Quote

As the vaccine is preventative, [it is] unlikely to impact positively on infected badgers”

End Quote Melanie Hill NFU regional director

It showed that vaccination reduced the incidence of TB in badgers by 74%, but did not look for any impact on infection levels in cattle.

The Labour government had planned five subsequent pilot vaccination projects, but the coalition reduced that to one, and Killerton was among the sites axed.
So at a cost of £80,000 per year, the National Trust is picking up the project, making use of the fact that some of the preliminary research (such as mapping out badger setts) has already been done.
Across about 20 sq km (8 sq miles) of the site, badgers will be lured into cages with bait and trapped.
Trained and licensed Fera staff will then deliver a dose of vaccine and release the badger, first marking it so it does not subsequently receive a second shot.
Dozens of setts have been identified, and the trust believes many hundreds of badgers will be vaccinated.
Promises made
The Conservative Party made badger culling a plank of their general election campaign last year.

Badger vaccination could reduce the need for cattle testing, or culling

Supporters of badger vaccination say it could reduce the need for cattle testing, or culling

The National Farmers' Union (NFU) has demanded it for a long time and after the election Agriculture Minister Jim Paice - a farmer himself - announced a public consultation into how it should be implemented in England.
While supporting the trust's decision to carry out the pilot programme, the NFU said vaccines formed part of the long-term solution but did not address the "desperate plight" that many farmers currently found themselves in.
"Current vaccination methods of injecting badgers is costly, and practically challenging with the benefits remaining unclear, and unproven," Melanie Hall, the NFU's regional director for South-West England told BBC News.
"As the vaccine is preventative, [it is] unlikely to impact positively on infected badgers."
Nationwide, nearly 35,000 cattle were slaughtered last year and there is no vaccine yet that can be used in cattle.
The government believes a cull would reduce disease incidence in cattle by 16% over nine years.
A spokesman for the Department of Environment, Food and Rural Affair (Defra) welcomed the National Trust's plans to run a vaccine pilot project.
He added: "There's no one solution to tackling TB, and the badger vaccine we developed is one of the tools we have available.
"We will be announcing a comprehensive and balanced TB Eradication Programme for England as soon as possible."
Ministers were expected to publish their plans to deal with bovine TB in the national herd in February; but amid turmoil over the disposal of nationally-owned forests, the announcement was postponed, and is now expected next month.
Meanwhile, the Welsh Assembly Government has announced new plans for a pilot cull in Pembrokeshire this year, after a legal ruling derailed similar plans last year.
Animal rights campaigners are to challenge the new plans in the courts.
Scientific cloud
Behind the issue lie conflicting interpretations of scientific evidence on the effectiveness of culling.
The Westminster and Cardiff governments and the NFU argue that culling can markedly reduce bovine TB incidence in cattle.
But the major UK investigation, the Randomised Badger Culling Trial (also called the Krebs trial), showed culling only produced a benefit if conducted rigorously and systematically over large areas, ideally with hard boundaries that badgers could not cross.
Otherwise, the social structure of badger groups broke down when some were killed, and the animals ranged further afield - infecting more cattle and leading to increased TB incidence.
"We're not against culling badgers if it's going to be effective in curbing bovine TB, but you can't apply the criteria everywhere that would make it effective," Mr Bullock told BBC News.
"Unless you have boundaries, you may have this effect where badgers move around and spread TB - we know from the science that this does happen."
Scientists who ran the Krebs trial have warned the government that its plan to allow shooting of badgers as they roam was likely to be less effective than the trap-and-shoot method deployed during the trial.
On that basis, they said, culling "risks increasing rather than reducing the incidence of cattle TB".
In the Irish Republic, culling has been practised for many years and does appear to have curbed bovine TB; but scientists involved with that programme say the disease will not be eradicated without vaccination.
The National Trust argues that vaccination could prove to be a more effective option than culling, in conjunction with tightened regulations designed to prevent cattle-to-cattle transmission.
This would also, of course, avoid killing badgers, which are a protected species under UK and EU laws.
Eventually, the aim is to have an oral vaccine that badgers would simply eat, avoiding any need for trapping; but that is thought to be five years away.

Badger vaccine project generates 'delight'

The UK's first independent badger vaccination project has proved that the technique is "viable and affordable", according to the charity running it.

The Gloucestershire Wildlife Trust vaccinated 35 badgers during the summer against the bacterium that causes tuberculosis (TB) in cattle.
The government wants to fight cattle TB in England through culling, but animal groups see vaccination as preferable.
The trial did not look for any impact on disease in badgers or cattle.
Instead, the idea was to see how feasible it would be to train staff and vaccinate the animals, and how much it might cost.
"We are delighted with the results (which prove) that there is an affordable alternative to the proposed cull," said Gordon McGlone, the trust's chief executive.
"Bovine TB is a big problem, but local culling of one of our much-loved native animals is not the answer.
"Scientists have spent the last 12 years investigating whether killing badgers will halt this serious disease in cattle, and the answer they are getting is that it could well make the problem worse."
The UK's so-called "Krebs Trial", the largest investigation of badger culling undertaken in any country, found that culling can reduce the incidence of bovine TB in the target area.
But if it is not done thoroughly and consistently over a large area, it can actually increase the disease burden, as badgers roam further from their setts when others die, taking bacteria to other farms.
Trial series
Conservation groups argue that vaccination does not carry this risk.

The 'Krebs Trial'

30 areas of the country selected, each 100 square km
10 culled proactively, 10 reactively, 10 not culled
Badgers culled through being caught in cage and then shot
Incidence of bovine TB measured on farms inside and outside study areas
Reactive culling suspended early after significant rise in infection
Trial cost £7m per year
More than 11,000 badgers killed
Latest follow-up studies equivocal on whether benefit of proactive culling is maintained

But the Gloucestershire experience suggests it might be more expensive than culling, with the wildlife trust reporting an average cost of £51 per hectare.

The true cost of culling will not be known unless and until it happens, but farmers' leaders believe it may be in the region of £20 per hectare.
The Gloucestershire Wildlife Trust hopes it will never happen.
They, and other conservation groups, argue that a combination of tighter restrictions on farmers and vaccination will be more effective, and that in any case, badgers should not be killed as a matter of principle.
The National Trust has also begun an implementation trial, at its property at Killerton in Devon.
Other wildlife trusts are expected to begin similar projects now that the Gloucestershire group has reported its positive experience.
The UK government, meanwhile, is midway through a second consultation period on its culling proposals for England.
It is not against vaccination, but believes the approach will have much more success when an edible formulation becomes available to supplant the existing injectable dose, which could take another four to five years.
In Wales, plans are on hold following May's election of a Labour government.

Thursday, 13 October 2011

Basic care given to elderly in hospital 'alarming'

By Nick Triggle Health correspondent, BBC News

The Care Quality Commission carried out 100 unannounced inspections

Too many hospitals in England are falling short in the most basic care they are giving elderly patients, inspectors say.

The Care Quality Commission carried out unannounced visits at 100 hospitals to assess dignity and nutrition standards.

It identified concerns in 55 cases, describing the findings as "alarming".

Common areas of concern included a lack of support for those who needed help eating, poor hygiene and curtains not being closed properly.

Health Secretary Andrew Lansley said he would encourage whistle-blowers to highlight any concerns they had about the standard of hospital care for the elderly.

He said: "We expect that staff across the NHS, if they see examples of poor care they blow the whistle on that, which is precisely why we have introduced changes to the staff contract."

The inspections were ordered by Mr Lansley after several highly critical reports by campaigners, including the Patients Association.

The 100 sites inspected - representing more than a third of the total number in England - were chosen through a combination of random selection and because previous research had flagged up concerns about standards.

'Major problem'

In total, 45 were judged to be fully compliant, 35 met both the official standards on dignity and nutrition although there was room for improvement and 20 were failing on one or both.

In two cases - Sandwell General in West Bromwich and Alexandra Hospital in Worcestershire - the problems were judged to represent a major problem to patients.

In the case of Sandwell, this led to the closure of the ward where there were the most problems, while a follow-up visit to the Alexandra showed measures had been put in place to rectify the issues.

At another - James Paget in Great Yarmouth - moderate problems were identified, but when a return visit was made and the issues had not been resolved the hospital was issued with a warning notice, meaning if swift improvements are not made it could face sanctions including prosecution or closure of services.

Examples of poor care

"The patient constantly called out for help and rattled the bedrail as staff passed by... 25 minutes passed before this patient received attention."
"We saw a staff member taking a female patient to the toilet. The patient's clothing was above their knees and exposed their underwear."
"Nobody was routinely offered hand-washing before or after their meals and hand gel was not within easy reach."
"Two members of staff who were assisting people with their meals at the time were having a conversation between themselves."
"The person did not have any assistance and the food was left on their table for over half an hour before they were assisted to eat."

During the inspections, the regulator identified a series of common problems.

These included call bells being placed out of the reach of patients, staff speaking in a condescending or dismissive way and curtains not being closed properly.

In terms of nutrition, some people who were judged to need help eating were not getting it, while interruptions meant that not all meals were being finished by patients.

The regulator also said that in too many cases patients were not able to clean their hands before meals.

The report identified three main reasons for the failures - a lack of leadership, poor attitude among staff and a lack of resources.

'Shocking complacency'

CQC chair Dame Jo Williams said: "The fact that over half of hospitals were falling short to some degree in the basic care they provided to elderly people is truly alarming and deeply disappointing. This report must result in action."

Michelle Mitchell, charity director of Age UK, agreed.

"This shows shocking complacency on the part of those hospitals towards an essential part of good healthcare and there are no excuses."

Janet Davies, of the Royal College of Nursing, accepted there could be "no excuse", but added the squeeze in finances was making it harder to keep standards high on wards.

"Evidence shows that patient safety and quality of care is improved when you have the right numbers and the right skills in place on wards," she added.

Both the government and the NHS Confederation, which represents managers, said examples of poor care were "unacceptable".

Mr Lansley added: "Everyone admitted to hospital deserves to be treated as an individual, with compassion and dignity. We must never lose sight of the fact that the most important people in the NHS are its patients."

Tuesday, 18 October 2011

Monday, 17 October 2011

Better hospital IT 'would save thousands of lives'

Better hospital IT 'would save thousands of lives'

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Monday, 17 October 2011

Black Death genetic code 'built'

The plague

Low birthweight 'linked to autism', says US study

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Trees 'boost African crop yields and food security'

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What is 'nitrogen-fixing'?

Saturday, 15 October 2011

Where did the story come from?

What kind of research was this?

What did the research involve?

What were the basic results?

How did the researchers interpret the results?

Conclusion

Links To The Headlines

Links To Science

Stromatolite colony found in Giant's Causeway

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Friday, 14 October 2011

Where did the story come from?

What kind of research was this?

What did the research involve?

What were the basic results?

How did the researchers interpret the results?

Conclusion

Links to the headlines

Links to the science

Related Stories

“Start Quote

The 'Krebs Trial'

Thursday, 13 October 2011

Basic care given to elderly in hospital 'alarming'

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Examples of poor care

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