Wednesday, 9 November 2011

Antibiotic resistance is driven by overusing antibiotics and prescribing them inappropriately

About antibiotic awareness

Antibiotics are important medicines. They help fight infections that are caused by bacteria. Antibiotic resistance (when an antibiotic is no longer effective) is a major problem. It is one of the most significant threats to patients' safety in Europe. Antibiotic resistance is driven by overusing antibiotics and prescribing them inappropriately. It's important that we use antibiotics the right way, to slow down resistance and make sure these life-saving medicines remain effective for us and future generations.

Watch the “Take care, not antibiotics” videos on this page

European Antibiotic Awareness Day (EAAD)

Every year, European Antibiotic Awareness Day is held on November 18. It's a Europe-wide public health initiative which encourages responsible use of antibiotics. The initiative is supported in England by the Department of Health and its Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI).

What is the problem?

Antibiotic resistance is an everyday problem in all hospitals across England and Europe. The spread of resistant bacteria in hospitals is a major issue for patients' safety.

Infections with antibiotic-resistant bacteria increase levels of disease and death, as well as the length of time people stay in hospitals.
Inappropriate use of antibiotics may increasingly cause patients to become colonised or infected with resistant bacteria.
Few new antibiotics are being developed. As resistance in bacteria grows, it will become more difficult to treat infection, and this affects patient care.

What is causing this problem?

Inappropriate use and prescribing of antibiotics in hospitals is causing the development of resistance.

Inappropriate use includes:

not completing a course of antibiotics as prescribed
skipping doses of antibiotics
not taking antibiotics at regular intervals
saving some for later

Inappropriate prescribing includes:

unnecessary prescription of antibiotics
unsuitable use of broad-spectrum antibiotics
wrong selection of antibiotics and inappropriate duration or dose of antibiotics

How can the problem be addressed?

Make antibiotic prescribing a strategic priority in hospitals by:

targeting antibiotic therapy
implementing structured antimicrobial stewardship plans
reviewing local surveillance and assessing microbiological data

Make antibiotic prescribing a priority in primary care by:

developing specific antibiotic prescribing guidelines for prescribers

Materials to support EAAD, November 18 2011 in England

To support EAAD and the promotion of sensible antibiotic use, the Department of Health (DH) and European Centre for Disease Prevention and Control (ECDC) have created information and educational materials for use in hospitals and primary care settings. You can download these and other materials from the DH website.

Bacteria 'linked' to Parkinson's disease

Bacteria 'linked' to Parkinson's diseaseFollow @westofmengele

Could this bacterium cause Parkinson's disease?

The bacteria responsible for stomach ulcers have been linked to Parkinson's disease, according to researchers in the US.

Mice infected with Helicobacter pylori went onto develop Parkinson's like symptoms.

The study, presented at a meeting of the American Society for Microbiology, argues that infection could play "a significant role".

The charity Parkinson's UK said the results should be treated with caution.

Parkinson's disease affects the brain and results in slow movements and a tremor.

Middle-aged mice, the equivalent of being between 55 and 65 in humans, were infected. Six months later they showed symptoms related to Parkinson's, such as reduced movement and decreased levels of a chemical, dopamine, in the brain.

These changes were not noticed in younger mice.

Toxic

Dr Traci Testerman, from the Louisiana State University Health Sciences Center, said: "Our findings suggest that H. pylori infection could play a significant role in the development of Parkinson's disease in humans.

"The results were far more dramatic in aged mice than in young mice, demonstrating that normal ageing increases susceptibility to Parkinsonian changes in mice, as is seen in humans."

The researchers believe the bacteria are producing chemicals which are toxic to the brain.

They said H. pylori was able to "steal" cholesterol from the body and process it by adding a sugar group.

The bacteria responsible for stomach ulcers may have a role in Parkinson's say researchers.

Dr Testerman said this new chemical was almost identical to one found in seeds from the cycad plant, which had been shown to trigger a Parkinson's-like disease among people in Guam.

She told the BBC: "H. pylori eradication in late stage Parkinson's disease is unlikely to result in significant improvement.

"Certain neurons are killed before symptoms begin, and more are killed as the disease progresses. Those neurons will not grow back."

Dr Kieran Breen, director of research at Parkinson's UK, said: "We believe Parkinson's is most likely caused by a combination of environmental factors together with an individual's genetic susceptibility to developing the condition.

He said there was some evidence that bacteria can prevent the main drug to treat Parkinson's, levodopa, being absorbed, but there was no strong evidence that people who have H. pylori in their gut are actually more likely to develop Parkinson's.

He added: "The current study is interesting and suggests that the bacteria may release a toxin that could kill nerve cells.

"However, the results should be treated with caution. The research was carried out in mice that were infected with relatively high doses of the bacterium or its extract.

"While they developed movement problems, we don't know whether this was actually due to the death of nerve cells. Further research needs to be carried out".

A new technique could improve the quality of life for patients with Parkinson's Disease

Cardiff University new Parkinson's therapy hope

MRI scan of a patient with Parkinson's Disease

A brain scan of a patient with Parkinson's disease. The blue box highlights a damaged region

A new technique could improve the quality of life for patients with Parkinson's Disease, according to research led by Cardiff University.

Patients with the early stages of the disease were trained to control areas of the brain associated with movement by using the power of thought alone.

A clinical evaluation later found their movement had improved by up to a third.

The charity Parkinson's UK described the research as "exciting" but stressed "these are very early days".

The study, published in The Journal of Neuroscience, involved ten patients with the disease that affects the brain and results in slow movements and a tremor.

Five patients received the brain regulation feedback technique and five acted as a control.

Activity mapping

“Start Quote

We wanted them to activate the brain regions associated with movement through the force of their mind”

Professor David LindenCardiff University

Patients undergoing the training were placed in a Magnetic Resonance Imaging (MRI) scanner in Bangor, Gwynedd. At first, they were asked to squeeze a hand as the team mapped the regions of the brain responsible for controlling movement.

Then, in real time, the subjects were shown the level of activity in these regions displayed on a gauge above them.

They were asked to imagine making complex movements in order to activate the brain centres, and saw a corresponding increase on the gauge. With practice, they were able to increase and decrease the level of activity at will, through thought alone.

Prof David Linden from Cardiff University, who led the research, described the process as "real-time neural feedback".

Motor function

"Self-regulation of brain activity in humans based on real-time feedback is emerging as a powerful technique," said Prof Linden.

Diagram from Cardiff University showing the principle of feedback in the research

Patients experienced a feedback effect as they learnt to control motion centres in their brain

"In this study we assessed whether patients with Parkinson's disease are able to alter their brain activity to improve their motor function. We wanted them to activate the brain regions associated with movement through the force of their mind," he explained.

The professor stressed that the technique did not offer a cure but he said that improved function could lead to a better quality of life.

"We found that the five patients who received neuro feedback were able to increase activity in brain networks important for movements and that this intervention resulted in an overall improvement in motor speed - in this case, finger tapping," said Prof Linden.

"The training resulted in clinically relevant improvement of motor functions - so assuming patients can learn to transfer the strategies used during neuro feedback into real-life settings, it might also become possible to sustain the clinical benefits," he added.

The research team said the study was a small scale proof of principle and they now hope to stage a larger, randomised, clinical trial.

“Start Quote

While these results are exciting, these are very early days”

Claire BaleParkinson's UK

'Amazing' brain

Claire Bale, senior research communications officer at Parkinson's UK, said: "This study showed that people with Parkinson's were able to alter their own brain activity to improve their movement symptoms using neurofeedback from brain scans. This highlights the amazing ability of the brain to change and adapt".

"While these results are exciting, these are very early days. We need much larger, in-depth studies to help us understand the potential these techniques may have to tackle some of the symptoms of Parkinson's," said Ms Bale.

The research into Parkinson's disease was the result of a collaboration between Cardiff University and scientists and doctors from north Wales, London and the Netherlands.

Prof Linden has also carried out a pilot trial using the neuro feedback technique on patients suffering with depression. The findings of that study are yet to be published.

Elderly care - 'shameful attitudes'

NHS: Elderly care dossier shows 'shameful attitudes'

Attitudes to elderly people in the NHS are shameful, says the Patients Association

A dossier containing "shameful" stories about the care elderly patients receive in NHS hospitals in England has been published by campaigners.

The Patients Association said the 16 cases include people being denied pain relief, left to sit in their own faeces and going without food and drink.

It comes after criticism from other groups and the charity said it was highlighting the tip of the iceberg.

The government said it was determined to "root out poor performance".

A programme of unannounced inspections would continue, the Department of Health added.Follow @westofmengele

Last month the Care Quality Commission attacked hospitals for what the regulator said were "alarming" levels of care.

The Health Service Ombudsman also raised concerns about the issue in February, reporting that nearly a fifth of complaints it got were related to the care of the elderly.

As well as highlighting the 16 cases, the Patients Association said the number of calls to its helpline regarding care on hospital wards had already hit 961 this year - a third more than the total made throughout the whole of 2010.

Left sitting in faeces

George Taylor was admitted to Chase Farm Hospital in London in August with a urinary tract infection and chest problem. His family said he received a shocking level of care q=while there.

On one day, he was told by a nurse to go to the toilet sitting in his chair because she did not have time to take him to a bathroom. He did and his family then found him sitting in his own faeces. His wife had to clean him up.

His family also said he was often not washed, and the smell became overpowering at times. He was also discharged too early and was soon admitted to another hospital, where doctors said he should not have been released at all.

Mr Taylor's daughter, Gaynor Marshall, said: "The nursing staff treated him as an object that they had to treat rather than a human being." A complaint has now been made about his care.

The Patients Association said the failings fell into four broad categories - communication, assistance going to the toilet, pain relief and nutrition.

And it called on NHS trusts to sign up to a pledge to ensure these four areas of care become top priorities.

It said responsibility for the problems lay with everyone from individual staff on the wards to senior managers on the board.

Among the cases highlighted are a patient who was left sitting in his own faeces for hours after a nurse told him he should empty his bowels in his chair because she did not have time to help him go to the toilet.

In another case, a family of a patient had to beg for pain relief for a dying woman before waiting for nearly two hours for help to arrive.

And one man had to wait for 15 minutes to have his call buzzer answered despite having to desperately struggle for breath.

It is the third time the Patients Association has published individual stories like this.

'Poor performance'

Katherine Murphy, the charity's chief executive, said: "We cannot ignore the fact that some trusts are not even paying lip service to the fundamentals of care.

Dying patient in 'terrible' pain

Sally Abbott-Sienkiewicz was admitted to Glenfield Hospital in Leicester in November last year. She was terminally ill with cancer and had developed pneumonia. She died within two days.

But throughout her time there, her family had to battle to get her pain relief. They said she was left in terrible pain - sometimes for more than an hour - as they argued with staff to give her sedatives. The worst problems were experienced during the night.

Her daughter Samantha White said at times her pain was "horrendous and horrific", but staff were too slow to react.

Suzanne Hinchliffe, chief nurse at the trust which runs Glenfield, said: "It is clear that we completely failed Mrs Abbott-Sienkiewicz and her family, and for that we remain very sorry." She added that measures were being taken to improve practices.

"The issues we continue to highlight are human rights issues. They show a lack of compassion and care and a shameful attitude to treatment of the elderly."

Peter Carter, general secretary of the Royal College of Nursing, said the patients had been "clearly failed" in the cases highlighted.

"Each and every nurse is personally accountable for their own actions and must act promptly to raise concerns if staffing levels or other pressures get in the way of delivering good patient care."

But he also said managers must take responsibility, pointing out that job cuts were making it more difficult to provide good care.

The publication of the Patients Association report has also coincided with an announcement by the government that it is looking to improve standards for healthcare assistants, who are providing an increasing amount of care on wards.

These staff are currently unregulated, but the Department of Health is looking to introduce new rules by 2013 to ensure that they reach a minimum training levels before being allowed to work. However, indications are that this will be a voluntary requirement, which has disappointed some.

A spokesman for the Department of Health said: "The Patients Association is right to raise these examples and issues, and we will work with them and with the NHS to sort these problems out."

mengele plus

Wednesday, 9 November 2011

Antibiotic resistance is driven by overusing antibiotics and prescribing them inappropriately

About antibiotic awareness