Wednesday, 22 February 2017

Accommodation Allowance Restored

Potential strike action by 4,500 non-consultant hospital doctors has been averted after agreement was reached on the restoration of a €3,193 accommodation allowance which had been abolished in 2012.
Doctors had gone to the High Court to seek restoration of the allowance, and had they won, it was estimated that it would have cost the HSE up to €120 million, when back money and interest were factored in.

The deal will add €13m to the annual public service pay bill

The case was due to be heard in the High Court today.
They had also threatened to ballot for industrial action.
The settlement will see the €3,193 allowance restored from 1 July, but with no back money.
The allowance will be worth €61.20 per week for around 4,500 NCHDs, and the total deal will cost €6m this year.
In a full year it will add €13m to the annual public service pay bill.

This comes on top of an extra €50 million for Garda pay, and €120 million for accelerated pay rises for other public servants earning below €65,000 a year.
The Government has pledged to fund the pay overruns from efficiencies and savings.
Informed sources said this deal means a smaller bill with no back money than would have arisen had the HSE lost the case - and also avoids the risk of industrial action.
The Department of Health and the HSE have also agreed to establish a new process for educational supports for non-consultant hospital doctors, under the auspices of the Workplace Relations Commission as part of the deal.
The HSE is still facing major disruption next month as nurses belonging to the Irish Nurses and Midwives Organisation are due to commence an indefinite work to rule on 7 March in a dispute over recruitment, retention and staffing levels.
Industrial action by around 10,000 health support staff belonging to SIPTU is also due to get under way on the same date.
Both management and unions acknowledge that the industrial action will result in longer waiting lists and more patients on trolleys.

Tuesday, 21 February 2017

MS Treatments Update: (UK)

A multiple sclerosis treatment being tested in patients can stop the disease for at least five years, say doctors.
The risky therapy involves wiping out the person's immune system with strong cancer drugs, and then rebooting it with a stem cell transplant.

Doctors say only some patients will be suitable to try it, particularly because it is so high risk.
Out of 281 people who had the treatment, nearly half benefited, but eight died shortly afterwards.
The work in JAMA Neurology is one of the largest and longest investigations of this aggressive MS treatment.
Mark Rye, 41 and from Surrey, had his transplant just before Christmas 2016. Two months on he is doing well. "It was a hard decision, knowing what could go wrong. My wife and I discussed it for many, many hours. We've got small children and I didn't want my MS to get worse and end up in a wheelchair.
"I did this to halt the condition and so that I can be there for my children, who are still so young. I want to be able to play rugby and football with them as they grow up."
What is not clear, is for how long the therapy might ultimately work.

MS is not fatal, but it is incurable.

The disease causes the immune system to attack the protective coating of nerves in the brain and spinal cord, which can create problems with a person's vision, walking and balance.

Nerve connections damaged in MS

Treatments aim to slow or stop the attack.
Researchers from Imperial College London gathered data from 25 centres in 13 countries that have been trialling the radical therapy known as autologous haematopoietic stem cell transplantation or AHSCT.
The idea behind the one-off treatment is to reset the immune system to stop it from attacking the body. But it requires toxic drugs to kill off existing cells in the patient's bone marrow, which is unpleasant and hazardous.
The medical trial data gives doctors and patients a better idea about who might benefit from the treatment.
The findings suggest that patients who are younger, who are not responding to other MS drugs and who have relapsing MS, might benefit from AHSCT.
Lead investigator Dr Paolo Muraro said the risks must be weighed up against the benefits.
"We previously knew this treatment reboots or resets the immune system - and that it carried risks - but we didn't know how long the benefits lasted.
"In this study, which is the largest long-term follow-up study of this procedure, we've shown we can 'freeze' a patient's disease - and stop it from becoming worse, for up to five years.
"However, we must take into account that the treatment carries a small risk of death and this is a disease that is not immediately life-threatening."
Advanced clinical trials are already under way to test how well AHSCT works compared to existing treatments for MS.
Last year, the BBC's Panorama programme was given exclusive access to several patients who have undergone the stem cell transplant.
Steven Storey was diagnosed with MS in 2013 and, within a year, went from being an able-bodied athlete to needing a wheelchair and losing sensation in much of his body.
He said: "I went from running marathons to needing 24-hour acute care. At one point I couldn't even hold a spoon and feed myself."

Within a few days of the transplant he was able to move his toes, and after four months he could stand unaided.
AHSCT is not routinely available on the NHS. If anyone with MS is considering it, they should speak to their neurologist, advises the UK MS Society, which has been funding this and other research.

Monday, 20 February 2017

New Children's Hospital

The Public Accounts Committee is to invite the board of the new Children's Hospital to appear before it, to explain the escalating costs involved in the project.

Fianna Fáil TD Bobby Alyward said the projected costs had escalated to €1.2bn before a sod had been turned. Previous estimates had put the cost at €650m before the building is equipped.

Previous estimates had put the cost of the Children's Hospital at €650m before the building is equipped
Previous estimates had put the cost of the Children's Hospital
at €650m, before the building is equipped

Committee Chairperson, Sean Fleming said the matter had been raised by Independent TD Mattie McGrath and members agreed to write to the board to invite them to appear before the committee.
Comptroller and Auditor General, Seamus McCarthy told committee members that it should be clear where cost escalations occur and why.
However, he also told the committee that the audit function was retrospective and his office could not get involved in decision-making.

Friday, 17 February 2017

Specialty in Surgery


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Specialty interviews in Medicine to-day are more similar to OSCEs than traditional job interviews.
This book has been specifically designed for doctors applying to core surgical training with a heavy focus on practice questions that are commonly asked at CST interviews.

Wednesday, 15 February 2017

'Superspreaders' - Ebola Virus

Most people infected with Ebola in the world's worst outbreak of the deadly virus contracted it from just a tiny fraction of patients known as "superspreaders", researchers have said.
Six in 10 cases of the disease, which ravaged the West African nations of Guinea, Liberia and Sierra Leone between 2013 and 2016, were caused by just 3% of infected people, according to research carried out by several health experts.

The Ebola epidemic infected more than 28,600 people and killed around 11,300 before coming under control last year
The Ebola epidemic infected more than 28,600 people
and killed around 11,300 before coming under control last year

If these superspreaders, who were most likely to be under 15 and over 45, had been identified and quarantined promptly, most Ebola cases could have been avoided, the study published in the Proceedings of the National Academy of Sciences found.
The slow international response to the epidemic outbreak was criticised in 2015 by medical charity Médecins Sans Frontières (MSF), which first raised the alarm over Ebola, for having created an avoidable tragedy that cost thousands of lives.

"It was the infected people who didn't make it to health centres, and into isolation, that drove the epidemic," said Amanda McClelland, emergency health adviser at the International Federation of Red Cross and Red Crescent Societies (IFRC).
"The lesson to be learned is that you need to find every single case if you are going to stop an outbreak," McClelland told the Thomson Reuters Foundation.
The Ebola epidemic infected more than 28,600 people and killed around 11,300 before coming under control last year.
Children under 15 years old and adults over 45 were the biggest spreaders of Ebola, according to the study, which examined 200 cases in and around the capital of Sierra Leone, Freetown.
Younger and older patients were more likely to have been looked after by many relatives and caregivers, thus fuelling the spread of the disease, several of the researchers said.
Many people in the three Ebola-hit countries contracted the virus, which is passed on through blood and bodily fluids, by holding and embracing the infected, and washing and touching the bodies of the deceased at traditional burials.
"People between the ages of 15 and 45 were most likely to be carers and caring for someone with Ebola is a big risk factor in contracting the virus," said Sebastian Funk, assistant professor at The London School of Hygiene & Tropical Medicine (LSHTM).
Superspreaders also fuelled epidemics of Severe Acute Respiratory Syndrome, or SARS, in 2003 and Middle East Respiratory Syndrome (MERS) in 2012, according to the study.

Tuesday, 14 February 2017

Nutrition Title Available

The second edition of Nutrition at a Glance is now available at 612.3 NUT

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Monday, 13 February 2017

Costs of Cigarettes!

The Irish Cancer Society has urged the Government to follow Australia’s lead and increase the cost of smoking after the southern nation announced plans to raise the price of a packet of cigarettes to AU$40 (€28.50) by 2020.

Marking World Cancer Day, the society highlighted that one in four cancer deaths in Ireland are caused by smoking, and said Ireland should follow Australia and make a bold pledge on pricing.
It said tobacco taxes are one of the most effective ways of cutting the number of people who smoke.
Donal Buggy, Head of Services and Advocacy at the Irish Cancer Society said: "We need to send a strong signal that the Government is serious about reaching its target of a tobacco-free Ireland by 2025.  
"To do this we need to follow the example of Australia, where significant spikes in excise duty, next to policies such as plain packaging, have seen a dramatic fall in the smoking rate to 12.8% by the middle of 2016. In Ireland, the smoking rate is just under 20%."
Around 20,000 people are diagnosed with invasive cancer in Ireland every year.
The number of new cases is rising annually and is projected to double by 2040.
Nearly 3,000 cancer deaths in Ireland annually, about one in four, are caused by smoking.
The Irish Cancer Society said keeping the price of cigarettes high and out of reach of young potential smokers is a key element of the strategy to reduce the smoking rate in Ireland.

Nearly 3,000 cancer deaths in Ireland annually, about one in four, are caused by smoking
Nearly 3,000 cancer deaths in Ireland annually, about one in four, are caused by smoking
Forest Ireland, a campaign group for smokers, has criticised the call to increase the cost of tobacco.
Spokesman John Mallon said: "Raising taxes on tobacco is an outrageous attack on the poor and the elderly. It will fuel illicit trade and drive law-abiding citizens into the hands of criminal gangs.
"Tobacco is a legal product and consumers shouldn't be punished or treated like lepers for exercising their right to buy or consume it."
He added: "It's very easy for senior executives with their high salaries to call for tax increases. If they have any empathy for ordinary people they should show a bit more compassion for those who enjoy smoking and are less well off."

In a statement to mark World Cancer Day, Minister for Health Simon Harris said the new National Cancer Strategy, which will be published shortly, will focus on cancer prevention, early diagnosis and further improvements to cancer treatment.
The statement noted that the World Health Organisation estimates that 30% to 40% of cancers are preventable.  
It added: "Ireland has led the way internationally in anti-tobacco measures and this continues to be a priority area for cancer prevention."

Friday, 10 February 2017

Headlines and Soundbites! Part (2)

Continuing Claudia Hammond's article on assessing medical information, through presenting a number of guidelines listed below -

She wondered whether the only way to be sure of the quality of what you’re reading, is to start employing the same tactics. So for the BBC’s radio series Health Check, Claudia turned to three experienced health journalists for their tips – Sarah Boseley, the health editor of The Guardian, James Gallagher, BBC Science and Health reporter and Ivan Oransky, Watchdog Columnist at Stat News and Distinguished writer in residence at New York University and she also added a few of her own.

1. First, look for the source of the article. Check that it’s from a newspaper, website or broadcasting organisation with a good reputation.

2. Ask yourself whether this finding is really plausible. If it looks too good to be true, it probably is.

3. If it’s described as “the secret that even doctors won’t tell you” then be wary. Doctors have little to gain by keeping effective treatments a secret. They want to cure people. That’s what they’re there for.

4. The bigger the claim, the more evidence you need to see that it’s true. If this really is a massive breakthrough (and of course massive breakthroughs do happen) it will have been tested on thousands of patients, published in medical journals and covered by the biggest media around the world. If it is something so new that just one doctor is recommending it, you would do well to wait for some more evidence before following any health advice.

5. If the article says the research has been published in a particular journal, do a quick search online to check that the journal is peer-reviewed. This means that before an article can be published, it is sent out for scrutiny by scientists working in the same field. Occasionally even peer-reviewed papers have to be retracted if the results are later discovered to be fraudulent, but the vast majority do stand. If the research has not been published in a peer-reviewed journal, be more sceptical.

6. Has the wonder treatment been tried in humans yet? Or only in a test-tube, or in mice?  If human trials haven’t taken place, the treatment could still be interesting scientifically and it could show promise, but it’s too early to say whether it will ever be a viable treatment for people.

7. The web can save you a lot of time. Check it out on a website that reviews media coverage of news such as Health News Review, and you might find they’ve done the hard work for you.

8. If not, search for the journalist’s name to see what they usually write about. If they regularly write about science or health they’re more likely to know the right questions to ask about a new treatment.

9. Do an online search for the story’s details, plus the word “myth” or “hoax”. You might find it’s already been critiqued elsewhere.

10. Finally, once you’ve established that a health story isn’t fake and has been published in a reputable journal, you might still want check the methodology of the research. NHS Behind the Headlines looks at studies in detail, discussing how they were done and whether they’ve been reported correctly in the press.

Thursday, 9 February 2017

Headlines and Soundbites! Part (1)

When the UK newspaper, The Independent, analysed the 20 most shared stories in the past year with cancer in the headline, more than half included claims which health authorities or doctors had discredited. Yet many millions of people had considered them interesting enough to share on social media.
If fake news stories about politics can influence voting patterns, then could health stories about unproven treatments result in people eschewing their current medical treatment in favour of the latest recommendation in an article they see? Some fear these articles could be dangerous.
How are people supposed to know whether something they see on Facebook or Twitter is based on good science?
On Facebook, it can be tricky to spot the truth (Credit: iStock)
On Facebook, it can be tricky to spot the truth

 People need to be wary of what they read, but how are they supposed to know whether something they see on Facebook or Twitter is based on good science? Every day I get dozens of emails from PR companies, sometimes about very good research, sometimes about nonsense. Like other health journalists, I spend time working out how to spot which is which.

Claudia Hammond - Health Journalist - BBC

Wednesday, 8 February 2017

BMI Linked to Memory Impairment

Lucy Cheke and her colleagues at the University of Cambridge recently invited a few participants into her laboratory for a kind of ‘treasure hunt’.

The participants navigated a virtual environment on a computer screen, dropping off various objects along their way. They then answered a series of questions to test their memory of the task, such as where they had hidden a particular object.
When examining what might have influenced their performance, you might expect that Cheke would have been more concerned with the participant’s IQ – not their waistline. Yet she found a clear relationship between their Body Mass Index – a measure of your weight relative to your height – and apparent memory deficits: the higher a participant’s BMI, the worse they performed on the Treasure Hunt task.
In doing so, Cheke has contributed to a small but growing body of evidence showing that obesity is linked to brain shrinkage and memory deficits. This research suggests that obesity may contribute to the development of neurodegenerative conditions such as Alzheimer’s Disease.
Surprisingly, it also seems to show that the relationship between obesity and memory is a two-way street: being overweight or obese not only impacts on memory function, but may also affect future eating behaviour by altering our recollections of previous eating experiences.

Cheke’s interest in the subject began unexpectedly. “At the time I was looking at the ability to imagine a future state, particularly in terms of making decisions about food,” says Cheke. “If you’re hungry, you’ll imagine your future self as being hungry, too, but obese people seem to make such decisions on fact-based judgements rather than imagining.”
One possibility was that the obesity might have been damaging their capacity for “mental time travel”. Scientific research has long shown that memory and imagination are intimately linked, as we piece together fragments of past recollections to predict how future events might pan out.
The link made sense, she says, with some signs that obesity affects areas of the brain known to be used in memory and imagination. In 2010, for instance, researchers at Boston University School of Medicine reported that healthy, middle-aged adults with increased abdominal fat tend to have slightly lower overall brain volume. In particular, the hippocampus, a deep brain structure sometimes called the brain’s printing press thanks to its role learning and memory, was significantly smaller in obese people compared to leaner individuals.
There were also some hints from animal studies. “In studies focusing on weight changes and eating behaviours in rodents, the animals were terrible at learning tasks such as the Morris water maze,” explains Cheke. “The more I looked into it, the more I expected to see memory deficits, but that question was still very much open.”
Hence her experiment with the treasure hunt. Sure enough the obese participants found it particularly difficult to remember the location of the different objects – adding some important evidence for her hypothesis, and supporting earlier findings that indirectly linked obesity to impairments of cognitive function.

(Credit: Getty Images)
Overeating may cause long-term changes to the
brain, damaging our recall

More recently, a brain scanning study including more than 500 participants confirmed that being overweight or obese is associated with a greater degree of age-related brain degeneration. These effects were biggest in middle-aged people, in whom the obesity-related changes corresponded to an estimated increase in 'brain age' of 10 years.
Obesity is a complex condition with many contributing factors, however; so exactly how it might affect brain structure and function is still unclear.
“Body fat is the defining feature of obesity, but you’ve also got things like insulin resistance, hypertension, and high blood pressure,” says Cheke. “These can go hand in hand with behavioural factors [such as overeating and lack of exercise] and they can all potentially cause changes in the brain.”
“For example, insulin is an important neurotransmitter, and there’s a lot of evidence that diabetes is associated with changes in learning and memory,” she adds, “but there’s also evidence that high body fat on its own leads to inflammation in the brain, which can also cause problems.”
Inflammation is another potential culprit. Psychologists from the University of Arizona examined data from more than 20,000 participants in the English Longitudinal Ageing Study, in which measures of memory, BMI, and blood plasma levels of an inflammatory marker called C-reactive protein were collected every 2 years between 1998 and 2013.
They found that greater body mass was associated with a decline in memory function, and also with higher levels of the inflammatory protein. Although these links are indirect, the results suggest that brain inflammation is one plausible mechanism by which differences in body mass might influence cognitive function in otherwise healthy, aging adults.

Two-way Street
This should be of particular concern, given recent evidence that the path between memory and obesity may go both ways, as attention and memory control our appetite and eating behaviour. In other words, a deficit in your memory could cause you to gain weight.
Early evidence that memory plays an important role in eating behaviour came from a 1998 study showing that patients with severe amnesia will readily eat multiple meals one after the other, because they could not remember that they had just eaten.
“This shows that when we’re deciding how much to eat we’re not just basing those decisions on physiological signals about how much food there is in our stomach, but also on cognitive processes like memory,” says experimental psychologist Eric Robinson of the University of Liverpool.
“If your memory’s impaired or just not very good then you might overeat,” he adds. “I wanted to know if this could be reversed. If you improve a person’s memory, could that be a useful way of getting them to eat less?”