Wednesday 14 November 2012

DNA sequencing of MRSA


DNA sequencing of MRSA used to stop outbreak

MRSA

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An outbreak of the hospital superbug MRSA has been brought to an end by UK doctors cracking the bacterium's genetic code.
It led to them finding one member of staff at Rosie Hospital, in Cambridge, who may have unwittingly carried and spread the infection.
They say it is the first time rapid genetic testing has been used to track and then stop an outbreak.
One expert said this would soon become "standard practice" in hospitals.
Doctors were concerned after MRSA was detected in 12 babies during routing screening.

MRSA

MRSA - or methicillin-resistant staphylococcus aureus - is a bacterial infection that is resistant to a number of widely-used antibiotics.
People can carry the bug without health problems and it is spread by skin-to-skin contact or through contaminated objects such as bedding.
It can cause life-threatening infections if the bug breaches the skin, such as through a surgical wound.
However, current tests could not tell if it was one single outbreak being spread around the unit or if they were separate cases being brought into the hospital. About one in 100 people carry MRSA on their skin without any health problems.
To find out, researchers at the University of Cambridge and the Sanger Institute embarked on more sophisticated version of a paternity test.
They compared the entire genetic code of MRSA bugs from each baby to build a family tree. It showed they were all closely related and part of the same outbreak.
After two months without a case and deep cleaning the ward, another case appeared. Analysing the DNA showed that it was again part of the outbreak and attention turned to a carrier.
Tests on 154 members of staff showed that one was also carrying MRSA, which may have been spread to babies in the unit. They were treated to remove the infection.
"We believe this brought the outbreak to a close," said Dr Julian Parkhill, from the Sanger Institute.
"This is really exciting for us because it gave the hospital the opportunity to intervene.
"We think this is the first case where whole genome sequencing has actually led to a clinical intervention and brought the outbreak to a close."
Bacterial DNABacterial DNA was analysed
The study was published in the medical journal Lancet Infectious Diseases.
Cheaper
The cost of working out the entire genetic code of a bacterium has plummeted from millions of pounds to about £50.
The time it takes has also fallen dramatically from months to hours.
Dr Parkhill said it could get even cheaper: "People are talking about the thousand dollar human genome.
"If you can do the human genome for a thousand dollars you can do a bacterial genome for one dollar."
Commenting on the research Prof Ross Fitzgerald, from the Roslin Institute at the University of Edinburgh, told the BBC: "The study clearly highlights the power of whole genome sequencing for resolving the source and the spread of an epidemic of hospital acquired infection such as MRSA.
"It will ultimately, within a small number of years, be standard practice for any hospital outbreak.
"I fully expect this to be rolled out as a standard approach in UK hospitals in the very near future."
Prof Sharon Peacock, from the University of Cambridge, said she wanted to develop a simple system that could be used easily by hospitals.
She said she envisioned a "black box" where the genetic sequence goes in and a simple report that can be used by hospital staff comes out.
"It could, for example, determine the species of the bacterium; it could determine antibiotic susceptibility, and it could provide information about what genes are present that are often associated with poor outcomes in patients."
Sir Mark Walport, director of the Wellcome Trust, said: "This is a dramatic demonstration that medical genomics is no longer a technology of the future - it is a technology of the here and now."

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overhaul is needed in the system for caring for people


'Catastrophic failings' in schizophrenia care

Nurse and patientAlternative ways of caring for patients with schizophrenia are needed, says the inquiry

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An independent inquiry says a major overhaul is needed in the system for caring for people with schizophrenia.
The Schizophrenia Commission, which was set up a year ago, says patients spend too long in "demoralised and dysfunctional" hospital wards.
Its analysis suggests the condition costs society almost £12bn a year - and treatment budgets could be spent more wisely to stop people from getting ill.
The government says mental health is one of its high priorities.
A spokesman said: "We are clear that people with mental health problems should be treated with the same high quality and dignified care as anyone else and we expect the NHS to make this happen."
The commission, which was established by the charity Rethink Mental Illness, says too much is spent on secure care - 19% of the mental health budget in England last year - with many people staying too long in expensive units.
Among the 42 recommendations, the report calls for a better use of "recovery houses" in the community, to provide an alternative to hospital admission.

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It is a scandal that in 2012 people with schizophrenia are dying 15-20 years earlier than the general population”
Paul JenkinsRethink Mental Illness
The average cost of a night in a mental health in-patient bed is £321 - meaning a typical admission of 38 days costing more than £12,000.
The commission says early intervention teams, which aim to help people before their hallucinations or delusions become severe, are popular and should be extended. The report claims some teams are being cut or diluted at the moment.
'Madhouse'
Prof Sir Robin Murray from King's College London, which chaired the commission, said: "If you have psychosis and your mind is disturbed, you need a period of respite and calm.
"But especially in inner cities, you get admitted to something like a madhouse. The nurses are often overwhelmed.
"If patients have had a bad experience and then a further relapse, it's more likely they will then have to be admitted by compulsion.
"The system is pervaded by pressure. People are locked up too often and for too long.
"There's a preoccupation with risk, and the idea that this is a madman with an axe. But people with schizophrenia are actually more likely to be attacked themselves.

Recovery

Dan Lowe, 36, began having psychotic symptoms 16 years ago.
He has been admitted to hospital four times, each stay lasting several months.
Dan found the stays in hospital sometimes made his paranoia worse.
He is now taking clozapine, a medicine which has helped him a lot.
Dan lives independently in Surrey, with support from a community psychiatric nurse.
He enjoys taking part in a regular computer course.
"There's no other condition where such an emphasis is put on the risk of an effect on other people."
The report says care of people with schizophrenia and psychosis is falling "catastrophically short".
An economic analysis for the commission highlighted an "exceptionally low" employment rate for people with schizophrenia of 7%, as well as disrupted education - because the illness often develops in young adulthood.
The authors said some of the costs of schizophrenia were unavoidable - but effective interventions, such as family therapy and making a concerted effort to find people jobs, were not being widely used.
Paul Jenkins, head of the charity Rethink Mental Illness, was also a member of the commission.
He said: "It's been over 100 years since the term 'schizophrenia' was first coined, but care and treatment are still nowhere near good enough.
"It is a scandal that in 2012 people with schizophrenia are dying 15-20 years earlier than the general population."
The report said tackling those worse chances of physical ill health would take many years, but made economic sense.
And it highlighted poor prescribing practice as another problem faced by people with schizophrenia, saying patients were not always receiving the most effective medication.
The report - titled The Abandoned Illness - concludes patients can be given hope and support, with the aim of stability or recovery.

Sunday 4 November 2012

Liverpool Care Pathway: Relatives 'must be informed


Liverpool Care Pathway: Relatives 'must be informed'Elderly man's hands

There will be a 12-week consultation on the proposed changes to the NHS constitution

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Relatives of terminally-ill patients would have to be consulted before a decision to withdraw food or water is taken, under new government proposals.
It comes after some patients were placed on the Liverpool Care Pathway - designed to relieve suffering - without their relatives' knowledge.
The government wants to ensure families are told of life and death decisions.
The instruction will be included in a number of proposed changes to the NHS Constitution to be unveiled on Monday.
The Liverpool Care Pathway was developed at the Royal Liverpool University Hospital and the city's Marie Curie hospice to relieve suffering in dying patients, setting out principles for their treatment in their final days and hours.
Supporters say it can make the end of a patient's life as comfortable as possible and the method is also widely backed by doctors and many health charities.
However, critics argue it can be inhumane.
The government has now said that the rules needed to be stricter, meaning relatives of patients are always consulted before the technique is applied.
'New right'
A Department of Health (DoH) spokesman said the proposed changes would set out a "new right" under the NHS Constitution, which was established by the Health Act 2009, but he stopped short of describing the move as a "legal requirement".
However, the spokesman added: "Anybody providing NHS services is required by law to take account of it [the NHS constitution] in their decisions and actions."
Some reports suggested health trusts that failed to involve patients and families in decisions could be sued, while doctors could face being struck off.
The DoH spokesman said it was unlikely policy had been developed on this as the proposal was still at an early stage.
Health Secretary Jeremy Hunt will launch a 12-week consultation on the proposed changes to the constitution - the formal statement of patients' rights - on Monday.
Health minister Norman Lamb said this week that it was "completely wrong" for terminally-ill patients to be put on a "pathway" to death without relatives being consulted.
Mr Lamb has called a meeting of doctors and patients to discuss worries about the pathway.
Meanwhile, Conservative peer Baroness Knight called for an inquiry into claims some people might have survived had they not received this treatment.

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110th birthday


Sunday, 4 November 2012

Britain's oldest man marks 110th birthday

 

Britain's oldest man marks 110th birthday

Reg Dean 2012Reg Dean said he felt "a year older" than 109

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Britain's oldest man is celebrating his 110th birthday.
A public concert was held on Saturday night for former church minister Reg Dean, from Wirksworth, Derbyshire, although he was unable to attend.
The Dalesmen Male Voice Choir, which he set up, will sing for him later.
Mr Dean, who was born in Tunstall, Staffordshire, on 4 November 1902, says the secret of his longevity is being lazy, but his family says it may be down to a potion he drank in India.
Having been unwell, Mr Dean was presented with his cake in bed.
Asked how he felt, he said: "A year older than when I was 109! It has been a long year but I feel much better now.
Reg DeanMr Dean served as an army chaplain during World War II
"I can't say enough (about the birthday celebrations), it's all very kind and I did not expect it and of course I shall have another one when I am 130."
Mr Dean, who has lived in Derbyshire since 1947, has lived through two world wars and 24 British prime ministers.
Indian elixir
Stationed in Burma as an army chaplain during World War II, Mr Dean continued to work as a minister until his retirement at the age of 80.
He also spent 10 years working as a teacher and has been married three times.
His son, Christopher said the family had its own theory about his long life.
"When he was out in India, just before World War I, he was given an elixir by a local there.
"He did a favour for one of the locals and this guy said, 'drink this and you'll live til at least 100'.
"And he said being naive 'I just drank it' - this muddy mixture and here he is now - no one can argue with that now."
Mr Dean became Britain's oldest man after the death of 110-year-old Stanley Lucas, from Cornwall, in June 2010.
The current world record holder is 115-year-old Jiroemon Kimura from Japan.

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Liverpool Care Pathway: Minister will listen to concerns


Liverpool Care Pathway: Minister will listen to concerns

Elderly patient waiting to be seen

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It is "completely wrong" for terminally ill patients to be put on a "pathway" to death without relatives being consulted, a health minister has said.
Norman Lamb has called a meeting of doctors and patients to discuss worries about the Liverpool Care Pathway - which can see water and food withdrawn.
A Conservative peer has called for an inquiry amid claims some people treated in this way could have survived.
Mr Lamb also defended the practice of paying hospitals for using the pathway.
He was reacting to reports in the Daily Telegraph that two third of NHS Trusts in England using the Liverpool Care Pathway regime have been paid sums totalling millions of pounds for reaching targets related to their use.
Relieving suffering
Responses to a Freedom of Information request by the paper have suggested that at least £12.4m has been paid out to trusts in the past three years.
The pathway was developed at the Royal Liverpool University Hospital and the city's Marie Curie hospice to relieve suffering in dying patients, setting out principles for their treatment in their final days and hours.

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Payments have been made to encourage and ensure that patients and their loved ones are involved in the critical discussions that take place at the end of life”
Norman LambHealth minister
Mr Lamb said any payments made in connection with the pathway happened at a local level, without the government's involvement.
"Payments should only be made to encourage better care for people at the end of life," he told BBC Radio 4's World at One.
"Payments have been made to encourage and ensure that patients and their loved ones are involved in the critical discussions that take place at the end of life. If that is the result of the system, then that seems to me to be a good outcome."
The Lib Dem minister, responsible for social care, said his "sole interest" was making the final days of someone's life as comfortable and dignified as possible whether they chose to be in hospital, a hospice or at home.
"This (the pathway) is an approach improving the experience at the end of life. This is an approach supported by Macmillan and Marie Curie. Would those organisations really advocate a programme that denied dignity to people at the end of life."
'Right to complain'
Mr Lamb said he wanted to hear about cases where patients or their families had not been properly involved in, or informed about, how they were being treated and had convened a "roundtable" of clinicians and patients groups later this month to discuss the issue.
"Families are right to complain when that happens and it is that sort of approach which has to be challenged," he added. "I am absolutely determined myself to ensure we do challenge that."
"I want to hear where things have gone wrong. I want to ensure we address that absolutely, but a lot of good things have happened in recent years to improve the experience at the end of life."
Conservative peer Baroness Knight, who is calling for an inquiry into suggestions the Liverpool Care Pathway had accelerated some people's deaths, said she had heard of cases where people were deprived of water without their consent.
"One man actually rang the police and asked 'let me get some water'," she told BBC Breakfast. "That cannot be right. To die needing water is not a pleasant experience."
"What I think has happened is that a good idea at the beginning has translated into some very heartbroken people who have seen their relative die when actually they could have saved them."
But Dr David Nicholl, a consultant neurologist, told the BBC he was not aware of any financial targets connected to the pathway and that he believed hospitals were only concerned with getting more resources for good quality palliative care
"It is quite explicit that patients, where possible, should be fully consulted and their families consulted.
"Where there have been problems, I would say it has not been with the pathway but due to a lack of communication."

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