Thursday 9 June 2011

drugs to treat the brain disorder Creutzfeldt-Jakob Disease (CJD) “have unexpectedly blocked the onset of Alzheimer's disease, the most common cause

A “surprise discovery” has allowed scientists to block Alzheimer's disease, The Independent reported. The newspaper said that researchers developing drugs to treat the brain disorder Creutzfeldt-Jakob Disease (CJD) “have unexpectedly blocked the onset of Alzheimer's disease, the most common cause of dementia”.

However, it is not correct to say that researchers have been able to “block” the onset of Alzheimer’s. The study in question carried out laboratory and animal experiments to investigate the binding between two types of protein. One of the proteins investigated (called the amyloid beta protein) builds up in Alzheimer’s disease. An abnormal form of the other protein (called the prion protein) causes CJD. Scientists found that blocking this binding of the proteins stopped the amyloid protein from affecting nerve signals in mouse brain samples and in the brains of live rats.

Alzheimer’s is a complex disease and is caused by the death of nerve cells in certain areas of the brain. What triggers the death of nerve cells in this disease is still not fully understood, and blocking the effects of the amyloid protein in this way may not be sufficient to stop nerve cells dying.

The interesting finding of this study suggests it could be worth testing antibodies that target prion proteins in Alzheimer’s disease. These antibodies have reportedly already been prepared for testing in human diseases such as CJD, which may mean they could tested for Alzheimer’s disease in humans sooner. However, it is likely that more testing of their effects in animals will be needed before human testing is attempted.

Where did the story come from?

The study was carried out by researchers from University College Dublin and other research centres in Ireland and the UK. It was funded by the Science Foundation Ireland, the Health Research Board, a University College Dublin seed funding grant, the UK Medical Research Council and the Department of Health.

The study was published in the peer-reviewed scientific journalNature Communications.

The Independent, The Daily Telegraph and Daily Mirror covered this study. The Independent and Telegraph reported that this research was in rodents, but the Mirror did not. The Independent’s suggestion that scientists have “blocked the onset of Alzheimer's disease” is not correct. They have only shown that a single effect of the amyloid beta protein on nerve cells (neurones) has been prevented, which is not the same as blocking the development of Alzheimer’s disease.

What kind of research was this?

This animal research looked at the interaction between certain proteins involved in the brain conditions Creutzfeldt-Jakob Disease (CJD) and Alzheimer’s disease. These proteins are respectively known as the prion protein and amyloid beta. Both these proteins are present in normal brain tissue, but they are also involved in disease. An abnormal form of prion protein is the cause of CJD, a degenerative brain disorder. In people with Alzheimer’s disease, amyloid beta builds up in the brain and forms abnormal deposits, known as plaques. Amyloid beta is thought to affect the function of nerve cells directly, by influencing the strength of connections between the nerve cells (synapses) and, therefore, affecting memory. The build-up of amyloid beta is also thought to contribute to the death of neurones in the brain, which is the cause of the symptoms of the disease.

Previous research has suggested that amyloid beta might need to bind to the prion protein to have an adverse effect on nerve cell function. The researchers discuss previous research that looked at blocking this binding using antibodies, types of special proteins that the immune system uses to help defend the body. Antibodies have the ability to bind to foreign substances, such as molecules on the surface of bacteria and viruses, allowing the immune system to identify and attack them. The researchers say that in a previous study, an antibody against prion protein was able to prevent it from binding to amyloid beta, reducing its toxic effects on neurones in the laboratory and in a mouse model of Alzheimer’s disease. However, other studies have suggested that not all the adverse effects of amyloid beta seem to need the prion protein to be present.

In this study, the researchers wanted to repeat some of these previous experiments to confirm their findings and to look further at the effects on neurone function of blocking the interaction between amyloid beta and prion protein.

This type of early study helps researchers understand what might be going on in a disease, and suggests potential “targets” for new drugs or treatments. These treatments can then be tested in the laboratory and on animals to try and identify which ones have the most promise for testing in humans. While experimental models in the laboratory and animal models of the disease are useful research tools, they are not exactly the same as human disease, and treatments do not always have the same effect when they are tested in humans.

What did the research involve?

The researchers carried out a wide range of experiments. First, they generated a standardised form of amyloid beta that they could use in their experiments, called amyloid beta-derived diffusible ligand (ADDL). They noted that this preparation is not identical to the brain-derived amyloid beta.

Next, they carried out some tests in brain slices from mice, which were taken from a region of the brain called the hippocampus. This is the area affected in Alzheimer’s disease. They tested the effects of ADDL on neurones in these brain slices. They specifically looked at the effect on a nerve signalling phenomenon known as “long-term potentiation”, which strengthens the connection between neurones and is involved in learning and memory. They then tested whether prion protein needed to be present for ADDL to have an effect within the brain. To do this, they repeated their experiments using brain slices from mice that were genetically engineered to lack prion protein. As well as using their laboratory-generated ADDL, they also repeated these experiments using amyloid beta extracted from the brain of a person with Alzheimer’s disease.

They then further investigated how the prion protein and amyloid beta interact. They did this to identify key parts of the proteins that allow interaction to occur, so they could target these with antibodies to see if this would stop the interaction. They then tested a range of antibodies against different parts of the prion protein to see whether this would stop it binding to amyloid beta.

Once they identified antibodies that blocked this binding, they looked at whether they could stop the effects of amyloid beta on long-term potentiation in mouse brain slices. Finally, they tested the effects of one of these antibodies in living rats. Again, they looked at the effects on long-term potentiation, which normally occurs in response to stimulating the rat’s brain with high-frequency electrical stimulation. They injected the rats’ brains with amyloid beta extracted from a human brain with Alzheimer’s and looked at the effect on long-term potentiation. They then tested whether pre-injecting the brains with the antibody before injecting amyloid beta blocked it from having an effect.

What were the basic results?

The researchers found that both amyloid beta preparations (one made in the lab and the other extracted post mortem from the brain of a person with Alzheimer’s disease) inhibited long-term potentiation in the brain slices from normal mice, but not from genetically engineered mice lacking prion protein. This showed that the prion protein needed to be present for amyloid beta to have this effect.

The researchers found that two anti-prion antibodies, called ICSM-18 and ICSM-35, that have been tested in human prion disease could block the binding of amyloid beta and prion protein in the laboratory. These antibodies were also able to stop amyloid beta from having an effect on long-term potentiation in mouse brain slices. ICSM-18 was also shown to stop the effect of amyloid beta on long-term potentiation in live rats.

How did the researchers interpret the results?

The researchers concluded that their findings confirm that prion protein binds to amyloid protein and facilitates amyloid’s damaging effects on the function of nerve cells.

They say that the two main antibodies they tested, ICSM-18 and ICSM-35, could block the effects of amyloid beta on neurone signalling (long-term potentiation). This confirms that these antibodies are candidates for testing as potential treatments for Alzheimer’s disease, either on their own or in combination.

Conclusion

This animal research supports the theory that the prion protein plays a role in the effects that the amyloid beta protein has on neurones. It also suggests that using antibodies can prevent at least one effect of amyloid protein on the nerve cells.

It is important to note that the study looked at only one effect of amyloid beta on nerve cells: the effect on one aspect of neurone signalling called long-term potentiation, which is involved in learning and memory. Alzheimer’s is a complex disease and is largely caused by the death of neurones in certain areas of the brain. What causes the death of neurones in this disease is still not fully understood. Blocking the effects of amyloid beta on long-term potentiation may not be sufficient to stop neurones dying and, therefore, to affect disease progression.

The interesting finding of this study suggests that antibodies that target the prion protein could be tested for their effects in Alzheimer’s disease. These antibodies have reportedly already been extensively tested in mice and prepared for use in human testing for prion diseases, such as CJD. This means that they may be able to be tested in human Alzheimer’s disease sooner than if these steps had not been taken. However, it is likely that more testing in animals will be needed before human testing is attempted.

Links to the headlines

Surprise discovery allows scientists to block Alzheimer's. The Independent, June 8 2011

CJD drugs could help Alzheimer's patients. The Daily Telegraph, June 8 2011

Mad cow drugs could help beat Alzheimer's. Daily Mail, June 8 2011

Links to the science

Freir DB, Nicoll AJ, Klyubin I et al. Interaction between prion protein and toxic amyloid β assemblies can be therapeutically targeted at multiple sites. Nature Communications, June 7 2011

'Chemical cosh' dementia drug prescriptions concern

'Chemical cosh' dementia drug prescriptions concern


Elderly woman There are around 750,000 people living with dementia in the UK

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More than 50 health and social care organisations are calling for fresh action to cut the prescription of "chemical cosh" drugs.

Around 180,000 people with dementia are thought to be prescribed antipsychotic drugs in the UK.

But 80% of those prescriptions are said by critics to be inappropriate.

Long-term use of the drugs can make dementia symptoms worse, reduce the ability to talk and walk and increase the risk of stroke and even death.

The Dementia Action Alliance - which includes the Alzheimer's Society, Age UK and the Department of Health - want all prescriptions for antipsychotics to be reviewed by the end of March 2012.

To help patients and carers, the Alliance has published a booklet giving information and advice about how to make sure antipsychotics are not prescribed inappropriately.

Powerful sedative

Antipsychotics have a powerful sedative effect and are often used when dementia patients become aggressive, agitated or distressed.

Start Quote

It is unacceptable that 1,800 people with dementia die prematurely every year as a result of antipsychotic medication”

End Quote Paul Burstow MP Care Services Minister

They are most commonly given to dementia sufferers in care homes and hospitals.

Guidelines say they should only be used as a last resort and over a short period of time, but the evidence suggests that in some cases they are being prescribed for years.

A study published in January 2009 showed the medication nearly doubled the risk of death for many dementia patients when taken over a prolonged period.

Chemical cosh

Jeremy Hughes, Chief Executive of the Alzheimer's Society, said it was unacceptable that people with dementia were having their health and quality of life put at risk because of antipsychotics:

"It is essential we bring an end to this chemical cosh and empower people with dementia and carers with the information they need to ensure they are not prescribed these drugs inappropriately. This call to action can do just that.

Michelle Freaser says two years on antipsychotics had "horrendous" side effects on her father Michael Rainford

"It's not just about reducing antipsychotics but also about improving quality care. This means developing alternative treatments and finding better ways to manage pain and other medical conditions."

Following an independent report for the government in November 2009 that found the drugs killed around 1,800 patients a year, ministers announced plans to cut prescribing rates by two-thirds within three years.

But new figures from the NHS Information Centre suggest prescription may have dropped by less than 20% over the past two years.

When in opposition, Paul Burstow, now Care Services Minister, campaigned to cut the use of the 'chemical cosh'.

"It is unacceptable that 1,800 people with dementia die prematurely every year as a result of antipsychotic medication. That is why I'm backing this campaign," he said.

"Reducing the use of antipsychotic medication is one of the Coalition Government's four key priorities for dementia. With the right support, people can live well with dementia and continue to do the things they enjoy for years after diagnosis."

Alternative therapies

The campaign is also being supported by Dr Clare Gerada, Chair of Royal College of General Practitioners.

"Dealing with very agitated or aggressive patients can be distressing, and it can be difficult knowing what to do for the best of the patient, but antipsychotics should in most cases only be used as a last resort, and for the short term.

"Antipsychotics have potential to do real harm to patients, including an increased risk of stroke. There are viable alternatives - including behavioural therapies - that we should encourage wherever possible to ensure the care our patients receive is appropriate, in their best interests and does not cause them harm."

Rebecca Wood, Chief Executive of Alzheimer's Research UK, the UK's leading dementia research charity, said:

"Action to reduce the prescription of these drugs and develop alternative treatments has lacked urgency.

"This campaign should renew that urgency and drive home the need to invest in more research so that safer, more effective treatments can be found."

Martin Green of the English Community Care Association, a body that represents care homes, said: "ECCA really welcomes the commitment by the Department of Health to reduce anti-psychotic prescribing and we want to see all sections of the system - primary care, acute hospitals, pharmacists and care homes - working in partnership to reduce inappropriate anti-psychotic prescribing".

Are you affected by this story? Does one of your family members have dementia and use chemical cosh drugs? Or perhaps they have stopped using them? If you are willing to be interviewed by the BBC about this subject please fill in the form below

Monday 6 June 2011

mrsa

Scientists in the UK have discovered a new strain of MRSA that appears to spread to humans from cattle and can cause life-threatening illness,” reported The Guardian. It said that a study of dairy herds had found the drug-resistant strain in cows' milk.
MRSA (meticillin-resistant Staphylococcus aureus) is usually detected using a technique called antibiotic-susceptibility testing. Borderline cases of MRSA are confirmed with molecular testing, which detects the presence of a gene that is common to these “superbugs”.
This study looked at strains of MRSA from cattle and humans to see whether they possessed any new genetic features that affect the reliability of these tests.
The study found a new type of gene in many of the cattle samples. This gene makes the bacteria resistant to a range of antibiotics. While the bacteria with this gene showed up in antibiotic-susceptibility testing, molecular testing could not recognise the gene and failed to identify the bacteria as MRSA.
Therefore, if molecular testing is used to detect MRSA or to confirm borderline cases, it will not identify bacteria with the new gene.
The researchers say that only a small proportion of MRSA bacteria possess this gene. However, as it has been detected in MRSA samples from dairy cows, these animals might form a “reservoir of infection”. They warn that close links with farms or contact with dairy cattle could increase the risk of MRSA being transmitted to humans. Further studies are needed to inform tests for diagnosing MRSA.
Experts highlight that the main worry is that bacteria may colonise people who work on farms, and not that people may be at risk from drinking milk. As almost all milk sold in the UK is pasteurised, drinking or eating dairy products is reportedly “not a health concern”.

Where did the story come from?
The study was carried out by researchers from the Department of Veterinary Medicine at the University of Cambridge and other health and academic institutions in Cambridge and the UK.
Funding was provided by the Department for Environment, Food and Rural Affairs, the Higher Education Funding Council for England, the Isaac Newton Trust (University of Cambridge) and the Wellcome Trust.
The study was published in the peer-reviewed medical journal The Lancet.
The news headlines have oversimplified this complex research and may imply that people are at risk from drinking milk, which is not the case. The main implications of these findings are in the field of laboratory and diagnostic testing.

What kind of research was this?
This laboratory study looked at strains of MRSA from samples taken from cattle and humans. The researchers wanted to see if they possessed any new genetic features that meant that they could not be detected by standard tests for diagnosing MRSA.
The researchers explained that animals are known to act as a “reservoir” for new strains of bacteria, so could be a source of new strains of the superbug MRSA (meticillin-resistant Staphylococcus aureus) in humans. Staphylococcus aureus causes a wide variety of infections in humans, from skin infections to pneumonia and blood poisoning. However, many people carry the bacteria harmlessly on their skin.
MRSA has developed resistance to meticillin and other penicillin antibiotics that would normally kill Staphylococcus aureus. This means that MRSA can cause disease that is harder to treat. It is believed that the Staphylococcus aureus bacteria evolved to develop this resistance by acquiring a certain chromosome element (called SCCmec) which contain a gene called mecA. This gene encodes a protein that binds to penicillin.
The researchers describe how MRSA is usually identified in the laboratory using “antimicrobial susceptibility testing”. In this test, the bacteria are incubated with discs that are impregnated with antibiotics. The zone around the disc where bacterial growth has been prevented is measured. There are standard zones around the disc that confirm the presence of MRSA. If the results are borderline, molecular testing (called PCR testing) is used to detect the mecA gene or penicillin-binding protein in the bacteria.
Before 2003, most cases of MRSA were associated with human transmission and infection, but after this time it was found in livestock. Evidence was also found that some strains may not be restricted to a single species but can cross between humans and farm animals. There is concern that farm animals could act as a reservoir for MRSA and that close human-animal contact could increase the risk of transmission.

What did the research involve?
The researchers took isolates (a pure strain that has been separated from a mixed bacterial culture) of MRSA bacteria from both humans and cows and determined whether antimicrobial susceptibility testing could detect the bacteria.
In 2007, the researchers obtained 24 isolates of bovine MRSA from the Veterinary Laboratories Agency in the UK. These came from a collection of 940 Staphylococcus aureus isolates obtained from the milk of 465 different herds of cows with mastitis, which had been submitted to the agency for testing.
Isolates of human MRSA were obtained from the Health Protection Agency and the Scottish MRSA Reference Laboratory in the UK, and the National MRSA Reference Laboratory in Denmark. The human bacteria had been cultured from blood samples or infected wound swabs.
The researchers carried out antimicrobial susceptibility testing on these bovine and human isolates, and used PCR testing to see whether the mecA gene could be detected.

What were the basic results?
A new mecA gene (called mecALGA251) was discovered in 15 of 24 Staphylococcus aureus isolates from dairy cattle in England. These isolates were from three different strains of MRSA. The new mecALGA251 gene was also identified in 12 of 16 isolates from human samples from Scotland, 15 of 26 isolates from England, and 24 of 32 isolates from Denmark.
Antibiotic-susceptibility testing identified that these isolates were resistant to a wide range of antibiotics. However, PCR testing showed negative results for the mecA gene and penicillin-binding protein. This suggests that if PCR testing is used on its own or to confirm the results of antibiotic-susceptibility testing, it may fail to identify the infection as being due to MRSA.

How did the researchers interpret the results?
The researchers concluded that routine culture and antimicrobial susceptibility testing will identify Staphylococcus aureus bacteria with the new mecA gene as being resistant to meticillin and related antibiotics. However, PCR testing to confirm the results will not detect this gene and will fail to identify the bacteria as MRSA. The researchers concluded that new guidelines for the detection of MRSA should consider including tests for mecALGA251.

Conclusion
MRSA is usually detected by using antibiotic-susceptibility testing. Results are confirmed using molecular testing (PCR), which detects the presence of the mecA gene that is common to these bacteria. This laboratory research tested MRSA obtained from cattle and milk samples, which were stored at veterinary agencies in the UK, and MRSA samples from humans, which were stored at reference laboratories in the UK. In many of the cattle samples tested, the researchers detected a new type of mecA gene. Antibiotic-susceptibility testing showed that MRSA bacteria carrying this gene were resistant to a range of penicillin-related antibiotics, but further PCR testing could not identify these bacteria as MRSA.
The most important finding from this research is that if molecular testing techniques are used to detect or confirm the presence of MRSA, they will not correctly identify the new type of MRSA bacteria.
The researchers noted that only tentative interpretations can be made from these results, and more samples need to be studied. Some points of note include:
The strains containing this new gene were only obtained from existing MRSA collections. Researchers will need to carry out the same tests in samples obtained from other populations.
It is not known whether disease caused by MRSA with the new mecA gene is any different to that caused by conventional MRSA.
According to the researchers, their data suggest that the MRSA infections with the new gene are likely to account for 1 in 100 to 1 in 500 of total MRSA in the UK and Denmark. This is a small proportion of MRSA infections.
As this gene has been detected in MRSA samples from dairy cows, it suggests that these animals might form a reservoir of infection. Close links with farms or contact with dairy cattle could increase the risk of this type of MRSA being transmitted to humans. As the study did not look at the spread of resistance from cattle to humans, this will need to be investigated in further research.
The discovery of this previously undetected MRSA, which carries the new mecA gene, is potentially important to public health. Further quality evidence is required from observational and experimental studies to inform tests for diagnosing MRSA.
Experts highlight that the main worry is that bacteria may colonise people who work on farms, and not that people may be at risk from drinking milk. As almost all milk sold in the UK is pasteurised, drinking or eating dairy products is reportedly “not a health concern”.
Links to the headlines
MRSA 'superbug' is found in British milk. The Independent, June 3 2011
New MRSA strain found in British cows' milk. The Daily Telegraph, June 3 2011
New strain of MRSA superbug may have spread from cattle to humans. The Guardian, June 3 2011
New form of MRSA found in cows' milk and human flesh wounds. Daily Mail, June 3 2011
Links to the science
García-Álvarez L, Holden MTG, Lindsay H et al. Meticillin-resistant Staphylococcus aureus with a novel mecA homologue in human and bovine populations in the UK and Denmark: a descriptive study. The Lancet Infectious Diseases, 2011 (published online first)
Further reading





end heading -->
Loeb MB, Main C, Eady A, Walkers-Dilks C. Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Database of Systematic Reviews 2003, Issue 4
Hughes C, Smith M, Tunney M. Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people. Cochrane Database of Systematic Reviews 2008, Issue 1

Friday 29 April 2011

Screen may spot autism

Screen may spot autism in one-year-olds

baby check The screen could be added to the list of health checks normally carried out a the one-year screen
Asking parents a few simple questions about their baby during routine one-year well-baby checks can help spot early autism, say US experts.
The condition, which affects how the child relates to other people, is usually only spotted some years later.
But enquiring about a child's use of eye contact, sounds, words and gestures can flag up early on if more detailed screening is needed, a study shows.
The findings in over 10,000 infants are published in the Journal of Pediatrics.
Of the 10,479 one-year-olds seen, 184 failed the initial check-up and were referred for further evaluation by the team at the University of California, San Diego School of Medicine.
To date, 32 have received a provisional or final diagnosis of autism spectrum disorder and another 101 have been found to have other conditions that involve developmental delay.
These rates, say the authors, are typical of what you might expect to see in a population of this size, suggesting that the screening could work.
Lead researcher Karen Pierce said: "Given lack of universal screening of infants for such disorders at 12 months, this programme could be adopted by any paediatric office, at virtually no cost, to aid in the identification of children with developmental delays.
"Importantly, parents will be able to get help for their children at a much earlier age than before."
Autism is a spectrum condition, which means that, while all people with autism share certain difficulties, their condition will affect them in different ways.
Early diagnosis
Some people with autism are able to live relatively independent lives but others may have accompanying learning disabilities and need a lifetime of specialist support.
The sooner the condition is diagnosed, the quicker they can access the care available.
Carol Povey, Director of the National Autistic Society's Centre for autism, said: "We welcome research which could help autism be diagnosed earlier.
"Whilst a formal diagnosis requires a comprehensive clinical assessment, screening checks at key developmental stages can help professionals identify children who may be showing signs of autism."



    Friday 8 April 2011

    Monkeys 'harbour malaria threat'

    Monkeys 'harbour malaria threat'

    Monkeys A type of malaria could move from monkeys to humans, say scientists

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    Scientists are warning that a species of malaria could switch from targeting monkeys to humans.

    Macaques in south east Asia are a vast source of Plasmodium knowlesi which can spread to people, they write in PLoS Pathogens.

    They believe that growing human populations and increased deforestation in the region could lead to the parasite switching host.

    But those changes could also reduce the spread of the disease.

    Around one million people die each year as a result of malaria.

    It is caused by parasites and is spread by mosquitoes when they drink blood.

    'Huge reservoir'

    P. knowlesi is known as the fifth malarial parasite in humans.

    It mostly exists in monkeys, however, there have been human cases and it has been shown in the laboratory to be able to spread from human to human.

    Start Quote

    With increasing human populations and deforestion we may get a shift to humans”

    End Quote Professor Balbir Singh University Malaysia Sarawak

    In south east Asia, the macaques are the second most common primate after humans.

    Blood tests on 108 wild macaques showed that more than three quarters were infected with the malaria parasite.

    Professor Balbir Singh, from the Malaria Research Centre at Universiti Malaysia Sarawak, told the BBC: "they are a huge reservoir of Plasmodium knowlesi."

    Genetic analysis showed that P. knowlesi had existed in monkeys since before humans settled in south east Asia. The researchers said humans were being infected from the 'reservoir', rather than the disease spreading between humans.

    Prof Singh raised concerns about what could happen in the future: "We don't know how mosquito behaviour will change.

    "With increasing human populations and deforestation we may get a shift to humans. The number of malaria cases is coming down so there is also decreased immunity. Or would deforestation reduce numbers? It could go either way."

    Dr Hilary Ranson, from the Liverpool School of Tropical Medicine, said: "It seems a very reasonable thing to speculate.

    "Deforestation or any perturbation of the ecosystem frequently leads to humans being exposed to an expanded range of biting insects and the pathogens they transmit, yellow fever is a good example of this."

    She said if humans catch the parastite more often then P knowlesi may evolve to target humans.

    "To me the important message is that disruption of the environment exposes people to a range of known and potentially unknown pathogens transmitted by blood feeding insects that do not typically feed on humans" she added.

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    Saturday 26 March 2011

    Welsh hospital food 'needs to improve', says auditor

    Welsh hospital food 'needs to improve', says auditor

    Hospital food tray The daily cost of feeding a patient varies from £1.33 to £5.66, says the report

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    Hospital catering is improving in Wales but more must be done to ensure patients get the right "nutritional care", a finance watchdog says.

    Many patients were satisfied with the food although not all received the help they needed at mealtimes, the auditor general said.

    Large amounts were also being wasted and the daily cost of patient meals varied greatly.

    Nursing chiefs said "significant work" had been done on improvements.

    The report said many Welsh hospitals provided patients with an "appropriate choice of good quality food".

    But there is still "much room for improvement", with the auditor general finding that not all patients get the help they need at mealtimes.

    What at-risk patients ate was not always recorded, and care plans were not always in place for those with nutritional problems, the report found.

    Auditor General for Wales, Huw Vaughan Thomas, said more needs to be done.

    "NHS organisations must recognise the importance of patient nutrition and ensure that there is effective leadership at ward level so that best practice is implemented," he said.

    Report recommendations

    • The need for the assembly government to develop and issue standard all-Wales nursing documentation to promote consistent nutritional screening and care planning
    • The need to develop a clear costing model for patient and non-patient catering services that supports meaningful comparisons of hospital catering costs across Wales
    • Setting clear pricing policies for non-patient catering services
    • Establishing local and national targets for food wastage
    • The need for NHS bodies to audit compliance with all aspects of the assembly government's nutritional care "pathway"
    • SOURCE: Wales Audit Office

    The report found the daily cost of feeding a patient ranged from £1.33 to £5.66.

    There was also an "unacceptably high" amount of food wasted on many wards which, if tackled, "could generate significant savings".

    "The cost of unserved meals on the wards we visited was approximately £1.5m," said the report.

    "If these wards reduced unserved meal wastage to the best performing wards in our sample, savings of over £758,000 could be achieved."

    The report found that where there was strong leadership, nutritional care was "invariably better".

    Chair of the assembly public accounts committee, Darren Millar, said: "Although hospital catering services in Wales have improved, a great deal still needs to be done to make sure patients get the nutritional care they need, that the amount of food waste on wards is reduced, and that better financial information on catering services is available," he said.

    Chief nursing officer for Wales, Prof Jean White, said she was pleased the "significant work" done to improve hospital food was recognised.

    Save money

    Patients were now assessed on arrival and a food record ensured dietary and nutritional requirements were given the same priority as medication.

    "Through Welsh Health Supplies, all NHS organisations in Wales already collaborate when procuring goods and services and are on target to save £20.7m in this year," she said.

    "Contracts ensure that food in hospitals is sustainable, safe, of good quality and procured efficiently."

    Prof White said they were also looking at linking with councils to buy-in supplies.

    Katherine Murphy, chief executive of the Patients Association, said the report provided "yet more evidence that the health service in Wales is still struggling to provide basic care for every patient."

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    Tuesday 15 March 2011

    European hospitals asked be on standby for Japan's ill

    European hospitals asked be on standby for Japan's ill

    Red Cross worker being checked for radiation exposure Workers in the area are checked for radiation exposure

    Five hundred bone marrow transplant centres across Europe are being asked to be on standby to treat Japanese radiation victims if the need arises.

    The European Group for Blood and Marrow Transplantation (EBMT) has alerting its members, which include 3,000 medics in specialist units.

    It is unclear how many in Japan might need their help, but the centres have plans and protocols ready to action.

    Many were drawn up after the 11 September 2001 terror attacks.

    It will be up to each centre to decide whether or not to take on any patients. In the UK there are 55 centres that could potentially help.

    The president of the EBMT, Professor Alejandro Madrigal, said: "We are asking centres to tell us their level of response and capacity so we can measure the level of commitment at centres."

    Professor Ray Powles, chair of the nuclear accident committee for EBMT, said it may be that between 20 and 30 workers at the nuclear Fukushima plant who are striving to contain the radiation will need treatment.

    "It is too early to tell yet, but it is better to be prepared.

    "If there was a humanitarian reason it would be something that could be offered.

    "We have contacted Japan directly and have also offered our services to them through the World Health Organization.

    "It's a logistic exercise.

    "We have had training sessions and have a consensus on how to treat people who have been exposed to radiation.

    "If workers have been exposed to harmful levels of radiation then we have a few days before they will get ill to plan their treatment.

    "They might just need antibiotics or they might need antibiotics and other drugs as well as blood and platelets. It's not that dissimilar to treating leukaemia."

    The treatment would largely be supportive care to manage the damaging effects of the radiation exposure. A few may require bone marrow transplants.

    Professor Powles stressed that these patients would not pose any radiation risk to others around them.

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    Tuesday 22 February 2011

    A watch-like device “could revolutionise blood pressure monitoring

    Blood pressure device performs well


    Monday February 21 2011

    undefined

    Wrist-worn blood pressure monitors are not new

    A watch-like device “could revolutionise blood pressure monitoring”, BBC News has reported. According to the website, the monitor can be used to measure pressure in the wrist, which can then be used to estimate pressure in the aorta, the largest artery in the body.

    Although news coverage has focussed on the wrist-worn monitor, the research devised a technique to combine blood pressure readings from the wrist and upper-arm to estimate central aortic systolic pressure (CASP). This measure of pressure in the aorta is thought to be a better way of predicting heart problems than traditional measures of blood pressure, such as using an inflatable cuff around the bicep.

    A device to measure blood pressure at the wrist is not new, and the method does not replace the traditional approach of using a cuff on the upper arm. However, the researchers’ method for combining the two results to estimate CASP appears to have some merit, and may filter into medical care.

    Where did the story come from?

    The study was carried out by researchers from the University of Leicester, the National Institute for Health Research, Gleneagles Medical Centre in Singapore and Healthstats International in Singapore. The study was financially supported by the Leicester National Institute for Health Research Biomedical Research Unit in Cardiovascular Diseases. The study was published in the peer-reviewed Journal of the American College of Cardiology.

    What kind of research was this?

    Blood pressure has been measured through a blood vessel in the upper arm – the brachial artery – for many years. However, there is a current debate about whether the blood pressure measured in the arm accurately represents the corresponding pressure in the aorta, the large blood vessel that carries oxygenated blood away from the heart. Recent evidence suggests that central aortic systolic pressure (CASP), the pressure exerted as blood is pumped out of the heart and into the aorta, is a better predictor of structural damage to the heart and blood vessels.

    In this study, researchers tested a mathematical algorithm to determine whether it could accurately estimate CASP using measurements of pressure in the radial artery at the wrist. The brachial artery in the upper arm divides at around the elbow, and the radial artery is one of the main branches of this, supplying blood to the forearm, wrist and hand.

    The best way to measure CASP is to insert a pressure sensor into the aorta, but this is invasive and is usually only done when people undergo a procedure known as cardiac catheterisation. The procedure involves making an incision into the groin or upper arm to gain access to the arterial system, then feeding a guide wire and sheath through the arterial system so that a tiny pressure sensor can be positioned into the aorta or heart.

    There are other ways to estimate CASP, such as reading the pressure in the radial artery and applying mathematical functions, called generalised transfer functions. Although this method is widely used, the application of generalised transfer functions has been criticised. In this study, researchers explored a different mathematical model to estimate CASP from the radial pressure.

    This study had three separate parts, each involving a different group of participants. In the first, the researchers tested some key mathematical properties of their model. In the second, they compared their new way of estimating CASP with a well-known, accepted mathematical method. In the final part, they compared their non-invasive estimates of CASP with measures taken with cardiac catheterisation in people undergoing surgery.

    What did the research involve?

    The researchers tested the application of a mathematical approach called the n-point moving average. This is commonly used in other fields of study to help filter data and find underlying trends.

    With each beat the heart contracts and relaxes, resulting in fluctuations in blood pressure over short periods of time. In their first experiment the researchers needed to determine how many tiny measurements of radial pressure their model would need to make within the cycle of a heartbeat. They enrolled 217 volunteers to help with this aspect of their model development.

    In the second study, they used blood pressure readings taken as part of a large study that ran in Leicester over the course of five years. From this, they had 5,349 individual blood pressure readings to validate their new approach to calculating the central aortic pressure.

    The final part of the experiment included 20 adults undergoing routine diagnostic cardiac catheterisation at the Gleneagles Medical Centre in Singapore. Their CASP was measured near the aortic valve directly in the heart. At the same time, a device was attached to their wrists to measure the radial pressure and a device was placed over the bicep of the same arm to measure the brachial pressure. The researchers were able to compare the measures of CASP from their model with the direct CASP measures in real time for up to three minutes.

    What were the basic results?

    The researchers determined the best structure for their model in the first group of volunteers. This structure led to estimates of CASP that closely approximated those derived through the more standard CASP estimation models. The accuracy of their estimates was not affected by age, gender, presence of diabetes or hypertension treatment in the participants.

    In the invasive blood pressure experiment, brachial blood pressure (the standard measure in the upper arm) overestimated blood pressure compared to direct measurement of pressure in the aorta. There was strong correlation and agreement between direct measures of CASP and those estimated by the researchers’ mathematical model.

    How did the researchers interpret the results?

    The researchers concluded that their study demonstrates that a “simple moving average method” can be applied to brachial blood pressure measured across the wrist to estimate CASP.

    Conclusion

    This complex study involved the application of mathematical approaches to derive a measure of CASP from both radial artery pressure and brachial artery pressure. The researchers have developed a mathematical algorithm that appears to accurately predict CASP.

    In commenting that a sensor strapped to the wrist that can “measure the pressure in the aorta”, The Independent misunderstood the mechanics of measures of radial pressure. The researchers measured pressure at both the wrist and at the upper arm and use mathematical approaches to convert them into an estimate of the pressure in the aorta.

    The HealthSTATS sensor mentioned in news coverage is certainly not the first device of its kind, and there are several monitors which can be strapped to the wrist to measure radial pressure. However, it seems that the study’s technique of combining it with a traditional upper-arm cuff readings to create an estimate of CASP has some merit. The researchers make it very clear that this technology does not replace the traditional inflatable cuff, and that both methods are needed.

    Past research suggests that CASP is a better marker of cardiovascular problems than upper-arm blood pressure readings. As such, more accurate measures of it, such as that allowed through this new approach, are likely to play a growing role in clinical practice

    Blood pressure ! Millions 'misdiagnosed by GPs'

    Patients will be sent home to test blood pressure as millions 'misdiagnosed by GPs'

    One in four under 40s give a misleadingly high reading due to 'white coat nerves'

    One in four under 40s give a misleadingly high reading due to 'white coat nerves'

    Patients suspected of having high blood pressure will be sent home to test themselves for an extra 24 hours to make sure they were not misdiagnosed in the doctor’s surgery.

    The additional tests follow concerns that some are being wrongly diagnosed because their blood pressure rises in the surgery - so-called ‘waiting room nerves’.

    Currently, anyone suspected of having high blood pressure is diagnosed by a GP with an inflatable arm cuff.

    They then have additional readings, but always at their surgery or in hospital.

    Under new draft guidelines, which are open to consultation, the National Institute for Health and Clinical Excellence proposes doctors do not rely solely on readings taken in their surgeries.

    Instead, after the initial assessment a patient should be sent home and asked to wear an ambulatory blood pressure monitoring, or ABPM, device.

    This is an inflated arm cuff which takes spot readings over a 24-hour period. Around eight million people in Britain are currently diagnosed with high blood pressure, and at least six million are on drug treatment, with the majority aged 50 and over.

    But experts say that up to a quarter of those under 40 are misdiagnosed because they develop ‘white coat hypertension’ in which their blood pressure gives a misleadingly high score because they are nervous.

    The new guidelines will not change the threshold for treatment but provide an additional check to make sure no-one is incorrectly labelled as having high blood pressure.

    In 2008, 32 per cent of men and 29 per cent of women in England had high blood pressure – defined as a systolic blood pressure of 140mmHg or over, or a diastolic blood pressure of 90mmHg or over – or were being treated for the condition.

    Under the Nice guidelines, if blood pressure measurements taken during a consultation are 140/90mmHg or higher, then extra confirmation should be obtained over 24 hours at home.

    Bryan Williams, professor of medicine at the University of Leicester, led the development of the guidelines.

    He said doctors currently have to bring patients back to the clinic twice or more to get an accurate reading.

    ‘As many as 25 per cent of young people might record having high blood pressure when they go to the doctor when they actually don’t have it,’ he added.

    ‘When you are older, you are more likely to be hypertensive but, if you are at the margins and particularly if you are younger, then there’s a big error rate with diagnosis.

    ‘Evidence shows that if you used ambulatory testing before you treat, you would get the correct diagnosis more often.’

    He said the guidance was not just cost-effective, but was cost-saving in the long run as less cash is spent on treatments.

    He added: ‘What we want to do is ensure that the treatment goes to those people who need it



    Read more: http://www.dailymail.co.uk/health/article-1359408/Patients-sent-home-test-blood-pressure.html#ixzz1EfwXZTGO

    Wednesday 16 February 2011

    Zinc can be an 'effective treatment' for common colds

    Zinc can be an 'effective treatment' for common colds

    Man sneezing Common cold viruses are spread by sneezes

    Related Stories

    Taking zinc syrup, tablets or lozenges can lessen the severity and duration of the common cold, experts believe.

    A review of the available scientific evidence suggests taking zinc within a day of the onset of cold symptoms speeds recovery.

    It may also help ward off colds, say the authors of the Cochrane Systematic Review that included data from 15 trials involving 1,360 people.

    But they say zinc cannot be used long-term because of toxicity concerns.

    Excessive amounts can cause nausea, vomiting, abdominal pain and diarrhoea.

    Now more work is needed to determine the exact dosing required, say the experts.

    Cold viruses

    Adults catch between two to four colds a year and children up to 10 a year.

    There is little a person can do to avoid these infections because the viruses responsible are so commonplace.

    Start Quote

    This review strengthens the evidence for zinc as a treatment for the common cold”

    End Quote The review authors

    Cold viruses can be passed from person to person not only by coughs and sneezes but also by touching contaminated surfaces such as door handles.

    There is no proven treatment for the common cold, but experts believe zinc medications may help prevent and lessen infections by coating the common cold viruses and stopping them from entering the body through the thin lining of the nose.

    It also appears to stop the virus from replicating, at least in laboratory tests.

    There is also the suggestion that zinc aids the immune system and may dampen down some of the unpleasant reactions the body has to an invading virus.

    Speedy recovery

    Lead researcher Meenu Singh, of the Post Graduate Institute of Medical Education and Research in Chandigarh, India, said: "This review strengthens the evidence for zinc as a treatment for the common cold.

    "However, at the moment, it is still difficult to make a general recommendation, because we do not know very much about the optimum dose, formulation or length of treatment."

    According to trial results, zinc syrup, lozenges or tablets taken within a day of the onset of cold symptoms reduce the severity and length of illness.

    At seven days, more of the patients who took zinc remedies every couple of hours during the daytime had cleared their symptoms compared to those who took placebos.

    And children who took 15mg of zinc syrup or zinc lozenges daily for five months or longer caught fewer colds and took less time off school.

    But the 15 trials in the review all used different treatment timescales and doses, making it impossible to reach a consensus.

    And the people who used zinc also reported more side effects, such as an unpleasant aftertaste or nausea, than the placebo group.

    Editor in Chief of the Cochrane Library, David Tovey, said: "This is a treatment that is showing some promise which, where treating the common cold is concerned, is unusual.

    "Although there are many over-the-counter cold remedies already available, we are not awash with things that can stop cold symptoms or greatly reduce their severity.

    "But there is still uncertainty about the best doses, timings and formulations and more studies will be needed to look at this."

    Professor Ronald Eccles, Director of the Common Cold Centre at Cardiff University, remained doubtful about zinc's benefits as a cold treatment in current formulations.

    He said zinc's toxicity would also be a potential concern if taken over longer periods.

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    Tuesday 15 February 2011

    Shocking accounts of poor patient care released-Helpline appeal launched

    Shocking accounts of poor patient care released-Helpline appeal launched

    Today the patients association publishes Listen to patients, Speak up for change, a collection of 17 firsthand accounts of hospital care of older patients from across the NHS. All told by people that had contacted our Helpline in the past year, these stories highlight serious failings in standards of nursing care, poor communication with relatives and an ineffective complaints handling system.
    A follow up to last year’s Patients not numbers, People not statistics it’s publication marks the launch of a fundraising drive (supported by the Daily Mail) for the Patients Association Helpline as we try to deliver a more active support service. We are seeking to raise £100,000.
    Find out what we will do with the money raised HERE
    Patients Association President Claire Rayner, who passed away earlier this year, wrote the foreword for last years report and her son Jay Rayner writes the foreword this year in memory of Claire. Commenting on the launch of the report her husband, Des Rayner, said
    “Let the haunting begin”
    in reference to Claire’s famous last words ("Tell David Cameron that if he screws up my beloved NHS I'll come back and bloody haunt him!").
    Chief Executive Katherine Murphy said:
    'Surely the essentials of nursing care are what every patient deserves and should get? The NHS should get this right all of the time. Lack of help with eating and drinking. Lack of help with personal hygiene. Lack of help with toileting needs. It is clear from the stories we hear on our Helpline that too many patients are being badly let down. It’s a scandal and it’s outrageous that has been persisting for years. Families are left with a life sentence of grief, with no lessons learnt and the same failings continuing.'
    ‘The fact this problem hasn’t been properly addressed before is a sad indictment of our society. If we continue to ignore the problem, then many millions of us will end up in a similar position in the years to come. We will regret not having spoken out. Every single one of us needs to say enough is enough.’
    ‘The people who wrote these stories were not asking for the earth. They just wanted their relatives to be cared for, to have their basic needs met, for staff to show their loved ones kindness and compassion. I think we’d all want that if we were in their shoes.’
    'The NHS has tried to bring back matron, but is hasn't worked. That absolute commitment to patient care seems to get sidelined by targets, finances and bureaucracy. What we need is a matron who can ignore all of that. They can tell Trust managers, ‘forget your strategic framework and middle manager initiatives, it is meaningless if patients are not getting the vital nursing care they are entitled to.'
    'We've been told for years that the NHS is listening to patients, but where is the proof? Complaints are not being listened to. That is a fundamental thing that needs to be put right. The whole complaints system needs to be reviewed urgently starting with surveys for complainants so we can find out where the really poor performers are.'
    'Patients and carers need to be able to call on a real advocate when they complain, someone to fight their corner.'
    ‘When we published our report in 2009 we were inundated and ever since we have heard story after story after story. Our calls are going up and with the help of the Daily Mail readers we will try to make sure everyone who contacts us gets the help they need.’
    Kieran Mullan from the Patients Association supported the story tellers during the difficult process of producing their accounts and commented:
    'Their grief is palpable. Many of them feel guilty that the system disempowered them so thoroughly. Taking part in the report reminds them they are not alone, that it was not their fault. It is the system they were up against that is at fault.'
    'It is vital that other people show the courage these people have shown because unless people speak out the problems will continue. It was a privilege to help them do this. We can't publish everyone's story, but everyone's story helps us to shout from the roof tops as loud as we possibly can.'
    'When I took the stories and showed them to Claire last year she was upset and then she was angry. We know she would have been even more angry that these things are still happening. We should all be angry. This is our NHS run by our Government. The NHS exists to meet our needs and the needs of our families and friends. We shouldn't tolerate such abysmal failings. Our story tellers are speaking out. They are saying enough is enough. We all need to get behind them.’
    On the plans for the Helpline, Michael Watson Helpline Manager said
    ‘We want the resources to help more individuals to make their voices heard locally. Whether that be writing letters to Trusts and MPs, putting them in touch with local patient groups, getting them expert advice. Anything we can do to help. At the moment we are limited to sign posting, helping people to help themselves. The need is just so great that we are determined to do more and we hope people can support us and donate to the appeal.’
    To make a donation by cheque please send cheques to The Patients Association, PO Box 935, Harrow, Middlsex, HA1 3YJ.
    To make a donation online please visi

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