Sunday 29 July 2012

Whooping cough

Whooping cough outbreak spreads to very young babies

By James GallagherHealth and science reporter, BBC News

Babies are offered a whooping cough vaccine at two, three and four months of age

The outbreak of whooping cough in England and Wales has spread to very young babies who are most at risk of severe complications and death, the Health Protection Agency has warned.

There were another 675 cases in June bringing the total to 2,466 for 2012 so far.

At this stage last year there had only been 311 cases.

Increased levels of whooping cough have also been reported in Northern Ireland and Scotland.

The main symptoms are severe coughing fits which are accompanied by a "whoop" sound as children gasp for breath.

Surges in the number of whooping-cough cases are seen every three to four years. This latest outbreak began at the end of 2011.

Before routine vaccination in 1957, whooping cough outbreaks in the UK were on a huge scale. It could affect up to 150,000 people and kill 300 in one year.

'Very concerned'

There have been 186 cases reported in infants under three months this year compared to 72 in the same period last year. Five babies have died from the infection.

Dr Mary Ramsay, the head of immunisation at the Health Protection Agency, said she was "very concerned" with the increase in cases.

She said: "Whooping cough can be a very serious illness, especially in the very young. In older people it can be unpleasant but does not usually lead to serious complications.

Whooping cough

It is also known as pertussis and is caused by a species of bacteria, Bordetella pertussis
It mostly affects infants, who are at highest risk of complications and even death
The earliest signs are similar to a common cold, which then develop into a cough and can even result in pneumonia
Babies may turn blue while coughing due to a lack of oxygen
The cough tends to come in short bursts followed by desperate gasps for air (the whooping noise)

"Anyone showing signs and symptoms, which include severe coughing fits accompanied by the characteristic 'whoop' sound in young children, but as a prolonged cough in older children and adults, should visit their GP."

In the UK, the whooping cough vaccine is given to babies after two, three and four months. A booster dose is given just before primary school.

Babies are not fully protected until the third jab. It is in the following years that protection is at its peak then it gradually fades. It means you can get whooping cough as an adult even if you had the infection or the jabs as a child.

The Department of Health's Joint Committee of Vaccination and Immunisation is considering ways to tackle the outbreak, such as giving teenagers or pregnant women a booster jab.

Vaccinations for medics working with young babies have already been recommended to protect them and prevent them from spreading the infection.

Figures for the end of March showed 27 confirmed cases in Northern Ireland, compared to 13 in the whole of 2011. At the end of March there had been 150 cases reported in Scotland compared to 22 in the first three months of 2011.

Prof Adam Finn, from University of Bristol, said: "The current vaccination programme has reduced whooping cough in children, but also pushed it back into older age groups.

"Immunity due to vaccine does not last as long as immunity due to infection so as the number of people who have had whooping cough in the past falls, population immunity falls and rates go up.

"This is happening everywhere, not just in the UK."

Wednesday 25 July 2012

Botox doctor suspended

Leading Harley Street Botox doctor suspended

By Guy LynnBBC News, London

Dr Harrison said he had performed more than 50,000 remote consultations since 2005

A Harley street doctor exposed in a BBC London investigation encouraging nurses to order potentially dangerous Botox drugs in one person's name for use on another has been suspended.

Dr Mark Harrison will not be able to practise as a doctor for up 18 months pending a review.

The General Medical Council (GMC) will decide whether he will face a fitness to practise panel.

Botox can normally only be prescribed by doctors or designated professionals.

If Dr Harrison faces a panel he will be assessed by the GMC's Medical Practitioners Tribunal Service.

It comes after the GMC banned doctors remotely prescribing injectable cosmetic medicines, such as Botox, on the phone, fax or online, without a face-to-face consultation.

Niall Dickson, chief executive of the GMC, said: "There are good reasons why these are prescription-only medicines, and we believe doctors should assess any patient in person before issuing a prescription of this kind."

Remote prescribing was common practice at Dr Harrison's company Harley Aesthetics - one of the UK's largest purchasers of the anti-wrinkle drug.

Nurses who have independent prescribing qualifications are able to prescribe any drug, including Botox, without the involvement of a doctor.

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I take my professional and moral obligations to both the patients who have treatments and the nurses who use the service extremely seriously”

Dr Mark Harrison

And nurses without this qualification are legally allowed to inject the drug under a doctor's direction, but risk being struck off for doing this remotely, unless in an emergency.

Dr Mark Harrison, the director of Harley Aesthetics, had built up a network of hundreds of nurses who phoned him on his mobile from across the UK to receive authorisation to inject patients immediately with Botox.

They paid Dr Harrison £30 for each conversation.

After concerns were raised to the BBC, an undercover researcher secretly recorded one of Dr Harrison's training days and joined his team of nurses.

Dr Harrison was secretly recorded explaining how prescriptions for Botox could be obtained in the names of friends and family and the stock of drugs could be used on walk-in patients.

If nurses were unable to reach him on his mobile at any time when they had a patient expecting immediate treatment, he encouraged them to inject their patients anyway and he would phone the patient later.

'Little bit naughty'

"If you can't get a signal, what you might do is do the treatment and then you ring through with the details and the phone number and we guarantee we'll always ring the client after the event," Dr Harrison was secretly recorded saying.

"That may be after the event, which is a little bit naughty."

The BBC then phoned him to see if this would really happen, claiming a new patient had already been injected.

Dr Harrison left a message on the voicemail of the "patient" and later sent a prescription.

Botox is a potentially dangerous medicine and should usually only be prescribed by a doctor

Senior doctors have said this amounts to a potential safety risk and would mean the nurse was breaking the law by injecting Botox without a prescription.

In a statement, Dr Harrison said he had performed more than 50,000 remote consultations since 2005, with no adverse affects on patient health.

He said the use of prescriptions in one person's name for the treatment of others was "common, almost universal practice throughout the aesthetics industry" and had "no consequence for patient safety".

Dr Harrison said the practice of a doctor phoning a patient after an injection "would never be encouraged and would never be acceptable for a new patient".

He added: "The decision to treat has been taken by the nurse and the doctor informed retrospectively."

Dr Harrison went on: "I can confirm that I take my professional and moral obligations to both the patients who have treatments and the nurses who use the service extremely seriously."

Dr Nigel Mercer, a leading cosmetic surgeon and former president of the British Association of Aesthetic Plastic Surgeons, was shocked by the BBC's findings.

He said: "This is a wake-up call. It's not an appropriate way for providing a medical service."

Thursday 5 July 2012

mengele: Elderly denied NHS care

Probe into 25 deaths after trust admits 'poor records'

By Jane DreaperHealth correspondent, BBC News

Imperial College Healthcare NHS Trust sign

The trust said it had been open and transparent about the matter

The deaths of 25 patients are under review by one of the UK's biggest NHS trusts, after it admitted "poor record keeping".

Westminster and two other London local authorities have expressed "extreme concern" about lost data on referrals at Imperial College Healthcare.

BBC News understands Imperial is still unaware of the outcomes of 86 patients who were referred for cancer tests.

The trust says it does not believe any patient has come to serious harm.

Imperial, which runs four big hospitals in London, has however admitted that patients may have faced "discomfort, worry and possible deterioration as a result of a delay".

In an unprecedented move, the trust was allowed to suspend the reporting of its waiting times for planned operations and diagnostic tests to the government for the first six months of this year.

Waiting longer

The trust has been unable to make contact with 86 people who were referred for a possible cancer diagnosis.

It made efforts to trace 87 patients, through GPs and by sending letters by recorded delivery to the last available address.

Seven letters were returned undelivered and just one patient contacted the hospital to be seen directly.

“Start Quote

The safety of our patients is an absolute priority”

Sir Richard SykesImperial College Healthcare chairman

And at the height of the problems in February, around 3,500 patients were waiting longer than the 18-week NHS target for treatment or operations. Currently the figure stands at 1,600.

Some of these patients - and some of the suspected cancer cases - were recorded as having been on the waiting list since 2009.

So far, 74 deaths have come under the spotlight. A review group is satisfied that 49 were unrelated to any problems caused by delayed treatment.

In a joint letter, Westminster, Hammersmith and Fulham, and Kensington and Chelsea Councils complained to the trust about its handling of the problem.

The letter said: "It seems to us there could be a possibility of clinical harm as a result of delays in the diagnosis and commencement of treatment arising from the trust's failings.

"We are unhappy that the trust appears to have responded to the scrutiny function of local authorities with a lack of openness and transparency."

Westminster Council's scrutiny committee will question Imperial's interim chief executive, Mark Davies, at a meeting on Thursday night.

An NHS source described the discovery of such long-waiting patients as "dynamite" and "appalling".

The source said: "I would be surprised if there were not similar scandals waiting to be uncovered at other London hospitals.

"London has problems because that is where so many of the long-waiters and financial problems are."

'Extremely sorry'

Imperial has blamed issues arising from multiple computer and record-keeping systems.

A spokeswoman said: "To date we have found no evidence that these patients have come to clinical harm as a result of our poor record keeping.

"We are extremely sorry that this situation was not identified and resolved earlier."

In a letter responding to the councils, the trust's chairman, Sir Richard Sykes, said: "The safety of our patients is an absolute priority.

"We have been handling this in an open and transparent manner. We did not want to raise undue concerns for people when the issue was actually with our data collection."

In a statement, the Care Quality Commission said it would continue to monitor the trust closely "to make sure that it complies with the essential standards of treatment and care that people are legally entitled to expect".

Thursday 21 June 2012

'oldest cave art'

Bristol researchers removing samples for dating from Tito Bustillo Cave

The El Castillo Cave has numerous red discs on its walls. One was dated to 40,800 years ago

Red dot becomes 'oldest cave art'

A look inside the Altamira Cave in northern Spain

Red dots, hand stencils and animal figures represent the oldest examples yet found of cave art in Europe.

The symbols on the walls at 11 Spanish locations, including the World Heritage sites of Altamira, El Castillo and Tito Bustillo have long been recognised for their antiquity.
But researchers have now used refined dating techniques to get a more accurate determination of their ages.
One motif - a faint red dot - is said to be more than 40,000 years old.
"In Cantabria, [in] El Castillo, we find hand stencils that are formed by blowing paint against the hands pressed against the wall of a cave," explained Dr Alistair Pike from Bristol University, UK, and the lead author on a scholarly paper published in the journal Science.
"We find one of these to date older than 37,300 years on 'The Panel of Hands', and very nearby there is a red disc made by a very similar technique that dates to older than 40,800 years.
"This now currently is Europe's oldest dated art by at least 4,000 years," he told reporters. It is arguably also the oldest reliably dated cave art anywhere in the world.
The team arrived at the ages by examining the calcium carbonate (calcite) crusts that had formed on top of the paintings.
This material builds up in the exact same way that stalagmites and stalactites form in a cave.
In the process, the calcite incorporates small numbers of naturally occurring radioactive uranium atoms. These atoms decay into thorium at a very precise rate through the ages, and the ratio of the two different elements in any sample can therefore be used as a kind of clock to time the moment when the calcite crust first formed.
Uranium-thorium dating has been around for decades, but the technique has now been so refined that only a tiny sample is required to get a good result.
This enabled the team to take very thin films of deposits from just above the paint pigments; and because the films were on top, the dates they gave were minimum ages - that is, the paintings had to be at least as old as the calcite deposits, and very probably quite a bit older.
The oldest dates coincide with the first known immigration into Europe of modern humans (Homo sapiens). Before about 41,000 years ago, it is their evolutionary cousins, the Neanderthals (Homo neanderthalensis), who dominate the continent.
Dr Pike's and colleagues' work therefore raises some intriguing questions about who might have authored the markings.
If anatomically modern humans were responsible then it means they engaged in the activity almost immediately on their arrival in Europe.
If Neanderthals were the artisans, it adds another layer to our understanding of their capabilities and sophistication.

The Panel of Hands: Produced by blowing paint over a hand pressed against the wall

The great antiquity of the paintings leads co-author Joao Zilhao, a research professor at ICREA, University of Barcelona, to think the Neanderthals produced the motifs. Finding even older paintings than the red dot at El Castillo might confirm that "gut feeling", he said.
"There is a strong chance that these results imply Neanderthal authorship," Prof Zilhao explained.
"But I will not say we have proven it because we haven't, and it cannot be proven at this time.
"What we have to do now is go back, sample more and find out whether we can indeed get dates older than 42, 43, 44,000.
"There is already a sampling programme going on. We have samples from more sites in Spain, from sites in Portugal and from other caves in Western Europe and so eventually we will be able to sort it out."
Tracing the origins of abstract throught and behaviours, and the rate at which they developed, are critical to understanding the human story.
The use of symbolism - the ability to let one thing represent another in the mind - is one of those traits that set our animal species apart from all others.
It is what underpins artistic endeavour and also the use of language.

Saturday 16 June 2012

Milk fats may alter gut bacteria

Milk fats may alter gut bacteria causing bowel diseases

By James GallagherHealth and science reporter, BBC News

Inflammatory bowel diseases are becoming more common

The rise of inflammatory bowel diseases could be down to our shifting diets causing a "boom in bad bacteria", according to US researchers.

Mouse experiments detailed in the journal Nature linked certain fats, bacteria in the gut and the onset of inflammatory diseases.

The researchers said the high-fat diet changed the way food was digested and encouraged harmful bacteria.

Microbiologists said modifying gut bacteria might treat the disease.

Inflammatory bowel diseases (IBDs), such as Crohn's and ulcerative colitis, affect one in every 350 people in the UK. When the gut becomes inflamed it can lead to abdominal pain and diarrhoea.

The researchers at the University of Chicago said the incidence of the diseases was increasing rapidly.

They used genetically modified mice which were more likely to develop IBDs. One in three developed colitis when fed either low-fat diets or meals high in polyunsaturated fats. This jumped to nearly two in three in those fed a diet high in saturated milk fats, which are in many processed foods.

“Start Quote

They also suggest an effective means of dealing with such diseases, by simply reshaping the microbial balance of the gut”

Dr Roy SleatorCork Institute of Technology

These saturated fats are hard for the body to digest and it responds by pumping more bile into the gut. This changes the gut environment and leads to a change in the bacteria growing there, the researchers said.

Treatments

One bacterium in particular, Bilophila wadsworthia, was identified. It thrives in the extra bile produced to break down the fats. It went from being incredibly rare to nearly 6% of all bacteria in the gut in the high-fat diet.

Prof Eugene Chang, of the University of Chicago, said: "Unfortunately, these can be harmful bacteria. Presented with a rich source of sulphur, they bloom, and when they do, they are capable of activating the immune system of genetically prone individuals."

However, he said this could lead to possible treatments as the gut bacteria could be "reshaped" without "significantly affecting the lifestyles of individuals who are genetically prone to these diseases".

Commenting on the research, Dr Roy Sleator, from the Cork Institute of Technology, said: "Not only do the authors provide, what is in my opinion, the first credible explanation as to how Western diet contributes to the unusually high incidence in inflammatory bowel disease; they also suggest an effective means of dealing with such diseases, by simply reshaping the microbial balance of the gut."

Wednesday 13 June 2012

Elderly denied NHS care

Elderly denied NHS care 'can sue'

By Michelle Roberts Health editor, BBC News online

Wellbeing and dignity must be upheld

Age discrimination by NHS hospitals is to be outlawed, ministers have announced.

From October, elderly patients will have the right to sue if they have been denied care based on age alone, says Care Minister Paul Burstow.
This will not mean patients can demand any treatment they want. Care decisions will still be judged according to clinical need by doctors.
But NHS staff will have a legal duty to consider wellbeing and dignity.

“Start Quote

It sends a clear message to service providers that discrimination law will in future also protect older people”

End Quote Michelle Mitchell Age UK

The decision, which applies to hospitals in England, Wales and Scotland, follows a consultation exercise on the issue by the Home Office.

The charity Age UK said it was long overdue but good news.
Equal rights Age discrimination in the workplace is already unlawful, but until now there was no equivalent legal requirement on public and private services.
This has led to inconsistent practices and unfair treatment, with the needs of older people in particular being ignored, the government says.

Too old?

When Kenneth Worden, from Chester, was diagnosed with an aggressive form of bladder cancer he was told by doctors that he was too old at the age of 78 to have surgery.
But his daughter Michele Halligan, who is trained as a midwife, disagreed. She was determined that her father should have the treatment in a bid to ease his distressing symptoms - he was in a great deal of pain and had disturbed sleep because of he had to use the toilet every half hour.
After more consultations Kenneth was eventually treated by surgeons at the Queen Elizabeth Hospital in Birmingham.
Three years on from his surgery he is fit and well with no signs of the cancer returning.

An investigation by The King's Fund recently found treatable conditions such as incontinence and depression were sometimes ignored in older patients.

Last year the Health Service Ombudsman accused the NHS of failing to meet "even the most basic standards of care" for the over-65s in England.
Mr Burstow said: "I have heard numerous stories from people who feel that they have been discriminated against.
"One 84-year-old lady told how her doctor had been treating her for angina for years.
"Two years ago, she had an appointment to have an operation on a bunion on her big toe. However, because of the angina, they sent her for a heart scan.
"They found that it was not angina, but actually a leaky valve. She asked if she could have this fixed and the doctors said: 'What are you bothered about, at your age?'
"I am pleased to say she stuck to her guns and said she wanted the job done. At long last, she has managed to get an appointment but the whole experience made her feel pushed aside.
"This is exactly the kind of discrimination we want to rule out in the NHS."

The ban means:

Chronological age alone will no longer be a barrier to treatment
Clinical decisions should be based on clinical need and how fit someone is regardless of age
There is an onus to consider the wellbeing and dignity of older people

There will be specific exceptions from the new law, for example insurance companies will still be able to use age when assessing risk and deciding prices.

Michelle Mitchell, charity director general of Age UK, said: "We hope the new law which will apply to the NHS, social care and other services will prevent older people being denied proper treatment because of their age.
"It sends a clear message to service providers that discrimination law will in future also protect older people."

Sunday 10 June 2012

Care for elderly 'let down by fragmented system'

COMMENTS (238)

By Jane DreaperHealth correspondent, BBC News

MPs want a single body for social care

Older people are being let down by a social care system in which they are "passed like a parcel" between services, a committee of MPs has said.

The Commons health select committee wants local areas in England to deliver "joined-up" care, health and housing.

Funding pressures were reducing older people's quality of life, MPs added.

The government said "urgent reform of the care and support system is needed", and that it was creating the conditions for more integration.

The committee's report said that the Health and Social Care Bill - currently making its way through Parliament - would not simplify a fragmented system in England.

Rather than the current system of multiple funding sources, the MPs are calling for a single local body with the power to commission health, support services and housing.

The precise model would depend on local circumstances, they suggest.

The committee says in its report: "Despite repeated attempts to 'bridge' the gap between the NHS and social care... little by way of integration has been achieved over a 40-year period.

"These separate systems are inefficient and lead to poorer outcomes for older people."

Funding gap denied

Evidence was cited in the report that services which worked together to help keep older people well could potentially save the NHS £2.65 for every £1 spent by, for example, avoiding emergency admissions to hospital.

“Start Quote

Growing demand makes it more urgent than ever before to convert fine words into fine deeds”

Stephen Dorrell MPHealth committee chairman

The committee visited projects which had successfully integrated care in Torbay, Devon, and Blackburn, Lancashire.

However, the report points out that the care trusts that had pioneered integration in these areas are due to lose their commissioning functions under the controversial Health and Social Care Bill.

The MPs acknowledged that the government was putting extra money into social care in England - but said they had still received a "weight of evidence" which pointed to funding pressures and service cuts.

The government's commitment of an extra £2bn a year for social care by 2014/15 was "not sufficient to maintain adequate levels of service quality and efficiency", the report claimed.

In a hearing with the committee, Health Minister Paul Burstow denied there was any gap in social care funding.

'Efficiency challenge'

The Conservative MP and former Health Secretary, Stephen Dorrell, who chairs the committee, said: "This government, like its predecessors going back to the 1960s, has stressed the importance it attaches to joined-up services.

"Growing demand, coupled with an unprecedented efficiency challenge, makes it more urgent than ever before to convert these fine words into fine deeds.

"It is impossible to deliver high quality or efficient services when the patient is passed like a parcel from one part of the system to another.

"We recommend that the government should place a duty on the new clinical commissioning groups and local councils to create a single commissioning process for older people's services."

Ministers in England are due to publish a White Paper on social care in the coming months.

The committee is calling on the government to implement the findings of the independent Dilnot Commission, which last year recommended a system in which the costs of care for individuals were capped.

MPs warned though that the future of social care should not be "dominated by a debate about the technical details of funding".

They said carers needed more support - but this was too often not identified by staff such as GPs and social workers.

'Disastrous'

The King's Fund think tank estimates that 890,000 people are not receiving the care services they need - a figure which is disputed by ministers.

A senior fellow at the King's Fund, Richard Humphries, said: "Delivering integrated care must assume the same priority over the next decade as reducing waiting times was given over the last.

"The committee is right to stress that a more ambitious approach is needed to achieve this based on co-ordinated commissioning and pooled budgets.

"We think this could go a stage further by moving towards a single assessment of the funding needs of the NHS and social care in future spending reviews."

The shadow care minister, Liz Kendall, said: "Far from focusing on what older people and their families really need, the government has instead wasted 18 months on its disastrous NHS reorganisation.

"As the committee points out, some of the best examples of integrated care have been achieved by Care Trusts, which will be swept away by the government's own Health and Social Care Bill."

Mr Burstow said: "Integrated care should be the norm. That's why we asked the NHS Future Forum to specifically work on this issue. They told us there is no single silver bullet when it comes to integration.

"What we have already done and continue to do is create the legal and financial conditions for more integration."

Your comments (238)

mengele plus

Sunday 29 July 2012

Whooping cough

Whooping cough outbreak spreads to very young babies

Whooping cough

Wednesday 25 July 2012

Botox doctor suspended

Leading Harley Street Botox doctor suspended

“Start Quote

Thursday 5 July 2012

mengele: Elderly denied NHS care

Probe into 25 deaths after trust admits 'poor records'

Probe into 25 deaths after trust admits 'poor records'

“Start Quote

Thursday 21 June 2012

'oldest cave art'

Red dot becomes 'oldest cave art'

Saturday 16 June 2012

Milk fats may alter gut bacteria

Milk fats may alter gut bacteria causing bowel diseases

“Start Quote

Wednesday 13 June 2012

Elderly denied NHS care

Elderly denied NHS care 'can sue'

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Too old?

The ban means:

Sunday 10 June 2012

Care for elderly 'let down by fragmented system'

Care for elderly 'let down by fragmented system'

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Sunday 29 July 2012

Whooping cough outbreak spreads to very young babies

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Sunday 10 June 2012

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