Monday, 25 August 2014

Doctors at a hospital in north-west London have begun treating a Briton who contracted Ebola in Sierra Leone.

Ebola: British man begins treatment in London hospital
British aid volunteer William Pooley, who worked with The Shepherd's Hospice to provide palliative care in Sierra LeoneWilliam Pooley, seen here, worked as a volunteer for The Shepherd's Hospice in Sierra Leone before he moved to serve on an Ebola treatment ward

Ebola outbreak

Doctors at a hospital in north-west London have begun treating a Briton who contracted Ebola in Sierra Leone.
William Pooley, a 29-year-old volunteer nurse, was described by a charity he worked for as a "hero".
Mr Pooley was flown to RAF Northolt in a specially equipped military aircraft on Sunday and taken under police escort to Hampstead's Royal Free Hospital.
He volunteered to go to care for victims of the Ebola outbreak which has killed almost 1,500 people.
His is the first confirmed case of a Briton contracting the virus during the current outbreak.
Tropical disease specialist David Mabey: Patient poses no risk to others
'Remarkable man'
Mr Pooley, believed to be from near Woodbridge in Suffolk, was flown out of Sierra Leone's main airport in Lungi, in a RAF C-17 transport aircraft.
He will be treated in a specialist isolation unit for patients with highly infectious disease, the only one of its kind in Europe.
A special tent ensures medical staff can interact with the patient but are separated by plastic and rubber.
Mr Pooley had worked as a volunteer providing palliative care at The Shepherd's Hospice in Sierra Leone from March until July.
He then requested to be relocated to the Kenema Government Hospital to serve on the Ebola treatment ward, after he heard reports that patients were being abandoned when health workers died from the virus.
Gabriel Madiye, the executive director of The Shepherd's Hospice, said Mr Pooley had been aware of the risks, but was determined to work there.
"We consider him a hero," he said. "Somebody who is sacrificing to provide care in very difficult circumstances - when our own health workers are running away."
Co-worker Gabriel Madiye tells 5 live: "We consider him a hero"
There is no cure for Ebola but with treatment of the symptoms, and proper hydration, patients have a chance of survival.
Prof Jonathan Ball, a virologist at Nottingham University, said there would be immediate testing to ensure all organs were functioning.
"He really is in the best place and will have the best possible care," he said.
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At the scene
A specialist isolation ward has been set up at the hospital in London
Jon Ironmonger, BBC News
Whisked into the Royal Free Hospital late on Sunday night under police escort was a man whose noisy arrival was quickly replaced by the everyday comings and goings of a rainy bank holiday morning.
Inside the building a rare drama is unfolding - the meticulous treatment of the first British person infected by the Ebola outbreak.
The volunteer nurse is being treated in an isolation unit which is the only one of its kind in Europe, and more sophisticated than any facility in west Africa.
Doctors will interact with him behind the plastic of an airtight tent to avoid the risk of contamination.
They will attend to his symptoms, particularly dehydration, but Ebola has no proven cure, so the main battle is down to him and his body's ability to fight the virus.
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Last week, two Americans who had contracted the disease in Liberia made a recovery and were discharged from hospital after being given an experimental drug called ZMapp in the US.
Officials in Liberia also said three medical staff have shown signs of improvement after taking the drug.
The US manufacturer of ZMapp has said supplies of the drug are exhausted, but the Department of Health said it was working to source any remaining doses.
Department of Health deputy chief medical officer Prof John Watson has said the risk of Ebola to the UK remains "very low".
Health officials insist the risk to the UK from Ebola remains "very low"
The World Health Organization has estimated 2,615 people in west Africa have been infected with Ebola since March.
Health officials have reported the first cases outside west Africa, in the Democratic Republic of Congo.
The virus is spread between humans through direct contact with infected bodily fluids. It is one of the world's deadliest diseases, potentially with a mortality rate of 90%. However, the current outbreak has a fatality rate of 55%.
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Ebola Virus Disease (EVD)
A fruit bat is pictured in 2010 at the Amneville zoo in France. Fruit bats are believed to be a major carrier of the Ebola virus but do not show symptoms
  • Symptoms include high fever, bleeding and central nervous system damage
  • Fatality rate can reach 90% - but current outbreak has mortality rate of about 55%
  • Incubation period is two to 21 days
  • There is no vaccine or cure
  • Supportive care such as rehydrating patients who have diarrhoea and vomiting can help recovery
  • Fruit bats, a delicacy for some West Africans, are considered to be virus's natural host
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Friday, 1 August 2014

Ebola crisis: Virus spreading too fast, says WHO

A Samaritan's Purse medical worker demonstrates personal protective equipment to educate team members on the Ebola virus in Liberia (undated photo) Dr Chan said that to date, more than 60 health care workers have lost their lives in the outbreak

The Ebola outbreak in West Africa is spreading faster than efforts to control it, World Health Organization (WHO) head Margaret Chan has said.
She told a summit of regional leaders that failure to contain it could be "catastrophic" in terms of lives lost.
But she said the virus, which has claimed 729 lives in four West African countries since February, could be stopped if well managed.
Ebola kills up to 90% of those infected.Ebola explained in 60 seconds
It spreads by contact with infected blood, bodily fluids, organs - or contaminated environments.
Initial flu-like symptoms can lead to external haemorrhaging from areas like eyes and gums, and internal bleeding which can lead to organ failure.
Dr Chan was meeting the leaders of the worst-affected countries - Guinea, Liberia and Sierra Leone - to launch a new $100m (£59m; 75m euro) Ebola response plan.
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Ebola since 1976
Graphic showing Ebola virus outbreaks since 1976
A map showing Ebola outbreaks since 1976
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"This meeting must mark a turning point in the outbreak response," Dr Chan said at the summit in Guinea's capital, Conakry.
"Cases are occurring in rural areas which are difficult to access, but also in densely populated capital cities," she said, explaining that the outbreak was the world's deadliest and largest in terms of geographical areas.
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Ebola virus disease (EVD)
Coloured transmission electron micro graph of a single Ebola virus, the cause of Ebola fever
  • Symptoms include high fever, bleeding and central nervous system damage
  • Fatality rate can reach 90%
  • Incubation period is two to 21 days
  • There is no vaccine or cure
  • Supportive care such as rehydrating patients who have diarrhoea and vomiting can help recovery
  • Fruit bats are considered to be virus' natural host
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Wednesday, 25 June 2014

Right-to-die

Right-to-die Supreme Court judgement due

Paul Lamb Paul Lamb won an earlier legal battle to join Tony Nicklinson's court challenge

Campaigners for the right to die are to receive judgement from the Supreme Court in the latest round of their legal battle.
It involves family of the late Tony Nicklinson, of Wiltshire, who had locked-in syndrome, and Paul Lamb, of Leeds, who was paralysed in a road crash.
They want the law changed to allow doctors to assist patients to die.
Judgement is likely to be issued on Wednesday.
The court has had to decide if the law prohibiting assisted suicide is incompatible with the European Convention on Human Rights because it denies Mr Lamb, and others like him, the right to choose the timing of their death.

Analysis

image of Clive Coleman Clive Coleman Legal correspondent, BBC News
The Supreme Court judgement is seen as perhaps the most ambitious attempt yet to change the law on the right to die.
Paul Lamb took up the legal challenge brought by the late Tony Nicklinson, who suffered from locked-in syndrome.
At a hearing at the Supreme Court last year his lawyers argued the current prohibition on assisting suicides interfered with his right to a private and family life, because it prevented the most severely disabled from getting medical assistance to end their lives at a time of their choosing.
Any doctor who helped someone to kill themselves would be guilty of assisting a suicide, a criminal offence that carries a maximum prison sentence of 14 years.
Subject to strict safeguards, including the medical assistance being sanctioned by a court, Paul Lamb wants any doctor who does assist a suicide of someone in his position, to have a defence in law.
The defence would be that of "necessity". However, many fear any change to the law on assisted suicide which would make the position of the sick, the infirm and the elderly, more vulnerable.
The fear is that members of these groups could easily feel themselves to be, or be persuaded that they are, a burden to others and decide to end their lives as a result.
A second man, known only as Martin, wants clarification of the director of public prosecutions's guidance on the position of health professionals who assist a suicide.
The existing guidance is unclear on whether they would be prosecuted.
There are nine judges on the panel, rather than the normal five.
'Unanimously dismissed' Paul Lamb, 57, has been almost completely paralysed from the neck down since a car accident more than 20 years ago and says he is in constant pain.
He has called for the law to be changed so any doctor who helped him die would have a defence against the charge of murder.
Tony Nicklinson was paralysed from the neck down after suffering a stroke while on a business trip to Athens in 2005.
After losing his High Court battle last year, he refused food and died naturally, aged 58, a week later at his home in Wiltshire. His widow, Jane, is continuing his legal battle.
Earlier last year, Mr Lamb joined forces with Mr Nicklinson's family to fight a joint legal case.
In their Appeal Court case, the decision centred on whether the High Court was right to rule Parliament, not judges, should decide whether the law on assisted dying should change.
The three Court of Appeal judges unanimously dismissed the Nicklinson and Lamb challenge.
In the judgement, the Lord Chief Justice Lord Judge said Parliament represented "the conscience of the nation" when it came to addressing life and death issues, such as abortions and the death penalty.
"Judges, however eminent, do not - our responsibility is to discover the relevant legal principles, and apply the law as we find it," he said.
At the same hearing a third paralysed man won his case seeking clearer prosecution guidance from the director of public prosecutions (DPP) for health workers who help others die.
Tony Nicklinson Tony Nicklinson suffered from locked-in syndrome
The man, known only as Martin, wants it to be lawful for a doctor or nurse to help him travel abroad to die with the help of a suicide organisation in Switzerland. His wife and other family want no involvement in his suicide.
The Supreme Court will also deal with the DPP's appeal against the Court of Appeal's ruling in Martin's favour.

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Saturday, 14 June 2014

NHS scan and test delays ‘worrying’

NHS scan and test delays ‘worrying’

in nhs 14 | Leave a comment

NHS scan and test delays ‘worrying’

Lung CT scanScans – like this one showing a lung tumour – are used to help diagnose cancers
 

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Health charities have called for urgent action to tackle delays in access to diagnostic tests in England.
The latest figures show that in April, nearly 17,000 patients had been waiting more than six weeks for scans and investigations – including for cancer.
NHS England says most patients are investigated promptly, despite a big rise in demand for tests.
The NHS constitution says no one should have to wait more than six weeks for a diagnostic test.
The number of such investigations has risen steeply in recent years in response to growing demand.
But the proportion of patients missing the deadline – including potentially some with cancer – has doubled in 12 months to more than 2%.
‘Top priority’
Macmillan Cancer Support said the NHS was “under strain” and there was a danger of cancer being “overlooked”.
 

“Start Quote

The vast majority of patients get their tests promptly”
End Quote NHS England spokeswoman
Ciaran Devane, Macmillan’s chief executive, said: “It is extremely worrying that the proportion of people who face delays in receiving vital tests which can diagnose cancer has doubled since this time last year, from 1.1% to 2.2%.
“Only two weeks ago we heard that more people are waiting longer to start treatment and now more people are waiting longer just to get diagnosed.”
He added: “Each individual hospital has a responsibility to meet these targets, or they risk putting a patient’s best chance of survival at risk.
“However, this government and the next also need to take responsibility. Macmillan Cancer Support is urging all political parties to make cancer a top priority at the upcoming general election.”
NHS England says there were more than 50,000 additional tests carried out in April compared with the same time last year, and that most patients wait less than three weeks.
A spokeswoman said: “Timeliness of diagnosis and treatment is what patients expect and is essential to providing high quality care. The vast majority of patients get their tests promptly.”
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Wednesday, 11 June 2014

the experts expressed concern about the medicalisation of healthy people




Scrap plan to extend statin use, say doctors

By Nick Triggle Health correspondent, BBC News
statin pill

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Proposals to extend the use of statin drugs should be scrapped, a group of leading doctors and academics says.
The National Institute for Health and Care Excellence published draft guidance in February calling for their use to be extended to save more lives.
It could mean another five million people in England and Wales using them on top of seven million who already do.
But in a letter to NICE and ministers, the experts expressed concern about the medicalisation of healthy people.
The letter said the draft advice was overly reliant on industry-sponsored trials, which “grossly underestimate adverse effects”.
And it added: “The benefits in a low-risk population do not justify putting approximately five million more people on drugs that will then have to be taken lifelong.”
The drugs reduce levels of cholesterol in the blood, lowering the risk of a heart attack or stroke.
The signatories include Royal College of Physicians president Sir Richard Thompson and former Royal College of GPs chairwoman Clare Gerada as well as cardiologists and leading academics.
Side-effects
Prof Simon Capewell, an expert in clinical epidemiology at Liverpool University and one of the signatories, said: “The recent statin recommendations are deeply worrying, effectively condemning all middle-aged adults to lifelong medications of questionable value.
“They steal huge funds from a cash-strapped NHS and they steal attention from the major responsibilities that government and food industry have to promote healthier life choices for ourselves and our children.”
Currently, doctors are meant to offer statin tablets to the estimated seven million people who have a 20% chance of developing cardiovascular disease over 10 years, based on risk factors such as their age, sex, whether they smoke and what they weigh.
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Statins and risk
• Statins are a group of medicines that can help lower rates of so-called “bad cholesterol” in the blood
• They do this by curbing the production of low-density lipoprotein cholesterol in the liver
• High rates of LDL are potentially dangerous as they can lead to hardening and narrowing of the arteries, known as atherosclerosis, which increases the risks of strokes and heart attacks
• Doctors use a risk calculator called QRisk2 to work out a person’s chance of having a stroke or heart attack to decide if they should be given statins
• The calculation factors include age, weight and smoking
• If someone has a 10-year QRisk2 score of 20%, then in a crowd of 100 people like them, on average, 20 people would get cardiovascular disease over the next 10 years
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But the draft guidance suggested that people with as low as a 10% risk should be offered the treatment.
Woman taking pill
Cardiovascular disease develops when fatty substances build up in the arteries and narrow them, which can lead to heart attacks and stroke.
Too much cholesterol in the blood can lead to these fatty deposits. Statin drugs work by lowering cholesterol.
Eating a healthy diet, doing regular exercise and keeping slim will also help lower cholesterol.
Like all medicines, statins have potential side-effects. They have been linked to muscle, liver and kidney problems, but just how common these are is a contentious issue.
One of the signatories to the letter is London cardiologist Dr Aseem Malhotra, who last month had to withdraw claims he made in a British Medical Journal article that a fifth of people who use statins experience side-effects.
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‘Extremely painful’
John Cakebread
“I was prescribed Simvastatin about nine years ago following heart problems,” says John Cakebread, from Kent.
“I stopped taking the medication six years later after researching the subject on the internet and finding out about side effects.
“I have now been left with peripheral neuropathy in the feet.
“This is extremely painful.
“My GP refuses to acknowledge this condition and that it could be caused by statins.
“He still wants me to take this medication, but I have refused.”
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Mike Knapton, of the British Heart Foundation, said NICE was right to want to extend the use of statins.
“Evidence shows that statins are a safe, effective, cholesterol-lowering drug and proven to lower the risk of heart disease.”
He added that, if anything, NICE should go further by looking at the lifetime risk rather than 10-year timeframe being proposed.
NICE has consulted on its draft proposals and is expected to publish final guidance at the end of July.
Prof Mark Baker, from NICE, said as well as the consultation the recommendations are being peer-reviewed.
He also pointed out that the guidance did not say patients had to go on these drugs – as GPs and patients can also discuss lifestyle changes to reduce risk – but just gave them the option of using them.
“This guidance does not medicalise millions of healthy people. On the contrary, it will help prevent many from becoming ill and dying prematurely,” he added.
BBC News – Scrap plan to extend statin use, say doctors
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Sunday, 8 June 2014

High-dose statins

High-dose statins 'raise risk of serious kidney problems'

High-dose statins taken by millions of people are putting them at increased risk of potentially fatal kidney problems, researchers are warning.

Advocates argue statins lower the risk of strokes and heart attacks, even among apparently healthy over 50s, but sceptics say side-effects reduce their value markedly.
Advocates argue statins lower the risk of strokes and heart attacks, even among apparently healthy over 50s, but sceptics say side-effects reduce their value markedly. Photo: Alamy
Stephen Adams
By , Medical Correspondent
6:30AM GMT 20 Mar 2013

Taking strong doses of simvastatin, atorvastatin or rosuvastatin increases the risk of being hospitalised with a condition called acute kidney injury, or AKI, by 34 per cent on average, found the Canadian team.
AKI is when the kidneys “suddenly fail to work as they should”, according to the Kidney Alliance, and causes anywhere between 62,000 and 210,000 deaths a year in Britain.
It is more common in those with long-term health conditions like heart failure, diabetes and chronic kidney disease.
Between five and seven million people take cholesterol-lowering statins in Britain, mostly over 60.
The vast majority take simvastatin, the cheapest type, although some take others including atorvastatin, better known by its brand name Lipitor, and rosuvastatin, sold as Crestor. These latter two are more potent, requiring smaller doses for the same effect.
Doctors prescribe different strengths depending on the patient’s cholesterol - the higher the level, the stronger the dose.
Researchers at the Lady Davis Institute for Medical Research in Quebec defined high-doses as 40mg+ for simvastatin, 20mg+ for atorvastatin, and 10mg+ for rosuvastatin.
After analysing the health records of two million Canadians, they found that among people without chronic kidney disease, those taking high-dose statins were at a 34 per cent increased risk of hospitalisation for AKI, compared to those taking low-dose statins.
Although this figure related to the first 120 days of treatment, the researchers said the increased risk seemed to last for two years.
Rates were not significantly increased in those who had chronic kidney disease. Their study is published in the online edition of the British Medical Journal.
Commenting in a related article in the BMJ, professors Robert Fassett and Jeff Coombes of Queensland University said more investigation was needed to find out what exactly was going on, including establishing a biological cause for the link.
Professor Donal O’Donoghue, the national clinical director for kidney care, said: "Every person on a statin needs careful assessment of their AKI risk."
He continued: "We know AKI occurs in over half a million people in the UK each year. At least 1 in 5 are due to medicines. This costs the NHS £1.3 billion per year.
"This new study shows the need to 'think kidney' when drugs are prescribed. In England there are over 55,000 excess deaths per year due to AKI – at least 12,000 are unnecessary."
But Peter Weissberg, medical director of the British Heart Foundation, said the apparent increased risk of AKI needed to be kept in proportion, because such kidney problems were “rare”.
He said: “These researchers have shown that people taking strong statins or high doses of weak statins are at increased risk of developing acute kidney injury, a serious but treatable condition.
“However, episodes of kidney damage are rare and need to be considered alongside the much larger number of heart attacks and strokes that are likely to be prevented by statins.
“It’s always important to take the lowest effective dose of any drug and most people in the UK are on low doses of statins unless there is a compelling medical reason for taking a higher dose.
“Further research is needed to establish whether it is the statins or the underlying blood vessel disease in people taking high doses that causes kidney problems.
“In the meantime, if you have concerns about your prescription, it’s important that you don’t stop taking your medication. Make an appointment with your doctor to talk it through.
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Sunday, 1 June 2014

New H10N8 bird flu 'not imminent global threat'

New H10N8 bird flu 'not imminent global threat'

By James GallagherHealth and science reporter, BBC News
Influenza virus

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The latest type of bird flu detected in China, H10N8, does not pose an imminent global threat, say researchers.
There have been three reported cases and two deaths since December 2013.
UK Medical Research Council scientists analysed the molecular structure of the virus to show it did not share the characteristics of previous pandemics.
Instead they argued resources should be focused on other flu viruses that are emerging or are already present in South East Asia.
There are a number of bird flus that are making the jump from animals to humans.
The phenomenon is most notable in China, where there is a large population that culturally lives closely with birds, such as live poultry markets.
H7N9 emerged in March last year and there were more than a hundred cases in the first month. There is also the longstanding threat of H5N1 influenza, which kills nearly two in three people infected.
'Need to be aware'
The study on the latest bird flu to emerge, published by the journal Nature, analysed how well the surface of the virus could bind to human tissue - a key measure of how likely it is to spread.
It showed the H10N8 virus still had a clear preference for infecting birds rather than humans, a trait that it is likely would need to be reversed before it became a serious threat.
Dr John McCauley, the director of the World Health Organization Influenza Centre at the Medical Research Council's National Institute for Medical Research, told the BBC: "This has been a pretty rare event in one place in China. It highlights the need to be aware, but I don't think there's an imminent threat.
"There are higher priorities than H10N8. Other avian influenzas emerging in China or those around for the past 10 years pose a more significant threat than H10N8."

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